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A study conducted by the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index that involved 105 patients with SLE with 8.98-year follow-up indicated that smoking exposure may have deleterious effects on lupus morbidity (123)

In effect, assuming North Carolina to be the primary source is a simplifying assumption but as we have argued above, it is a reasonable assumption that should not be far from the truth

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