1,2,3Seraj Makkawi, 4Nedaa Alsulaimani, 1Fahad A Alharbi, 4Reem Brashi, 4Renad Melebary, 4Shuaa Aljabri, 4Khalid Altowairqi, 4Albaraa Ashoor, 4Amal Alkhotani

1College of Medicine, King Saud Bin Abdulaziz University for Health Sciences & King Abdullah International Medical Research Center, Jeddah, Saudi Arabia; 2King Abdullah International Medical Research Center, Jeddah, Saudi Arabia; 3Department of Medicine, Ministry of the National Guard-Health Affairs, Jeddah, Saudi Arabia; 4College of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia


Multiple Sclerosis (MS) is an autoimmune disease that can be disabling to patients. Smoking has been proposed to be a risk factor for MS and to increase the risk for progression of the disease and its severity. However, it is still not clear how smoking affects MS patients regarding disease phenotype, symptoms, relapses, course, and disability. We aim to investigate the effect of smoking patients with MS patients living in Saudi Arabia.

Material(s) and Method(s):

This is an online questionnaire-based cross-sectional study. MS patients were randomly contacted through different MS societies and associations to participate in the study. The questionnaire inquired about demographics, MS phenotype and severity, and smoking status of participants. Data were collected between 30th of May 2021 and 5th of July 2021.


429 MS patients participated in the study. The mean age was 33.7, with a mean disease duration of 8.1 years. 61.1% of participants were female. 62.2% did not know the specific MS phenotype they have. 35.7% were current or previous smokers, with a mean smoking duration of 13.9 years. Smoking was significantly associated with the presence of multiple MS symptoms (p-value = 0.009) and their number (p-value = 0.050). In addition, there was a significant positive correlation between pack-years smoking and the number of MS symptoms with a Pearson’s r value of 0.209 (p-value < 0.05). No significant associations were found between smoking and recent relapses and disease progression, disability in terms of walking, needing a cane, or needing a wheelchair.


Smoking was shown to have a significant effect on the number of symptoms experienced by MS patients. Higher pack-years of smoking correlate positively and significantly with a higher number of MS symptoms. Further studies to examine these relations are hence warranted.