McKown T, McKown M, Unnithan R, et al. - This study was carried out to evaluate the correlation between smoking history and pack-year exposure on the rate of end-organ damage in systemic lupus erythematosus (SLE). Researchers performed SLE incident cohort including patients who met American College of Rheumatology (ACR) 1997 or SLE International Collaborating Clinics (SLICC) 2012 SLE criteria and had rheumatology encounters at a US academic institution (2008–16). The median time to SLICC/ACR damage index (SLICC/ACR-DI) increase or death was the primary endpoint. Smoking status and pack-years were the main explanatory variables. They assessed damage increase-free survival by smoking status and pack-years using Kaplan-Meier and Cox proportional hazards methods. Past or current smoking predicted new SLE damage 4-5 years earlier in this incident SLE cohort. The findings suggested that after adjustment, current smokers and patients with a pack-year history of > 10 years accumulated damage at twice the rate of never smokers.