If You Have Rheumatoid Arthritis and You Smoke, Listen Up

Tossing your cigarettes may help control your rheumatoid arthritis, according to research presented this week at the American College of Rheumatology Annual Scientific Meeting in San Francisco, Calif.

Rheumatoid arthritis is a chronic disease that causes pain, stiffness, swelling, and limitation in the motion and function of multiple joints. Though joints are the principal body parts affected by RA, inflammation can develop in other organs as well. An estimated 1.3 million Americans have RA, and the disease typically affects women twice as often as men.

Smoking is known to increase the risk and severity of RA. Smoking cessation has been shown to have a positive impact in slowing the progression of other diseases such as coronary disease and emphysema.

Researchers recently evaluated 14,847 patients with RA based on their smoking status. Of those, 65.4 percent were non-smokers, 22.1 percent were former smokers, and 12.5 percent were active smokers. Smoking cessation was defined as patient-reported cessation over two consecutive physician office visits, and independent variables in the study included patient age, gender, ethnicity, rheumatoid factor status, and use of different therapies for treating RA.

Researchers primarily monitored change in Clinical Disease Activity Index—a composite measure of disease activity in people with RA that assesses change over time— as well as other measures of disease activity including tender and swollen joint counts and laboratory tests.

Among 1,405 patients who smoked at enrollment into the registry, 21.1 percent successfully stopped smoking. In comparing this group to patients who continued to smoked, researchers found no significant differences in disease duration, rheumatoid factor or CCP status, non-biologic DMARD or biologic use. However, at the last follow-up visit, Clinical Disease Activity Index was higher among active smokers than among patients who had stopped smoking. Individual measures of active disease including swollen and tender joint counts and C-reactive protein were all lower in the patients who had stopped smoking.

These results suggest that stopping smoking can lessen RA disease activity over and above current medical treatment.

"While these results are preliminary, it seems that quitting smoking, which would have many other health benefits, also may benefit patients with rheumatoid arthritis,” explains Mark C. Fisher, MD, MPH; Research Fellow, NYU Medical Center; Hospital for Joint Disease, New York, N.Y. “RA patients who stop smoking may see an improvement in the number of joints that hurt them every day and in how they feel overall,” he says, noting that further research is necessary to confirm these early findings.

The ACR is an organization of and for physicians, health professionals, and scientists that advances rheumatology through programs of education, research, advocacy and practice support that foster excellence in the care of people with or at risk for arthritis and rheumatic and musculoskeletal diseases. For more information on the ACR’s annual meeting, see www.rheumatology.org/annual.