Smoking and rheumatoid arthritis

Also see:

• Seror R, et al. Passive smoking in childhood increases the risk of developing rheumatoid arthritis.
  Rheumatology, key219, 14 August 2018.  This study confirms that active smoking is associated with an increased risk of RA. It suggests for the first time that passive exposure to tobacco during childhood might also increase the risk of RA in future light smokers and probably non-smokers. Our results highlight the importance of avoiding any tobacco environment in children, especially in those with a family history of RA.

• Joseph RM, et al. Smoking-related mortality in patients with early rheumatoid arthritis – a retrospective cohort study using the Clinical Practice Research Datalink.  Arthritis Care and Research March 2016. Current smoking is associated with an increased risk of all-cause, cardiovascular and lung cancer mortality in patients with RA. Each year of cessation is associated with a reduced risk of all-cause mortality.

• Health Promoting Health Study (HPHS): Rheumatoid arthritis and smoking – a joint problem
• Di Giuseppe, D., et al. Cigarette smoking and smoking cessation in relation to risk of rheumatoid arthritis in women. Arthritis Research & Therapy. [online].15:R56. Abstract available from: http://arthritis-research.com/content/15/2/R56/abstract
• Lahiri M, et al. Using lifestyle factors to identify individuals at higher risk of inflammatory polyarthritis (results from the European Prospective Investigation of Cancer-Norfolk and the Norfolk Arthritis Register—the EPIC-2-NOAR Study)Annals of the Rheumatic Diseases, doi:10.1136/annrheumdis-2012-202481.

ASH Scotland information briefing on smoking and rheumatoid arthritis
November 2012

Key points:

• smoking is a major preventable risk factor for rheumatoid arthritis (RA)
• the increased risk due to smoking is dependent both on the amount of smoking and an individual’s genetic make-up
• smoking contributes at least 25% of the population burden of RA and the risk is dose-related, stronger in males and especially strong for anti-citrullinated peptide antibody positive (ACPA+) rheumatoid arthritis
• the proportion of RA attributable to smoking is similar to that seen for ischaemic heart disease
• heavy smoking - more than 20 pack-years of smoking - approximately doubles the odds of rheumatoid arthritis in both men and women
• people with rheumatoid arthritis have an increased risk of cardiovascular disease, lymphoma and lung cancer,  and osteoporosis compared to the general population and these are also established risk factors of smoking
• smoking can compromise the effectiveness of RA medications
• rheumatoid arthritis may be more severe in smokers than in non-smokers
• it may take up to 20 years after smoking cessation to return to baseline risk which is yet another reason to advise young adults not to start smoking.

The National Rheumatoid Arthritis Society has collaborated with NHS Fife and Pfizer to develop a campaign (leaflet pictured left) to raise awareness of the link between RA and smoking  and to encourage people with RA to think twice about smoking.  This leaflet and supporting campaign materials are available from the National Rheumatoid Arthritis Society: www.nras.org.uk

Further information and support

• National Rheumatoid Arthritis Society:  www.nras.org.uk
  Helpline (freephone): 0800 298 7650, weekdays between 9.30am and 4.30pm.
• Arthritis Care: www.arthritiscare.org.uk
  Helpline (Freephone): freephone 0808 800 4050, weekdays 10am to 4pm.
• Arthritis Research UK: www.arthritisresearchuk.org/
• Health and Social Care Alliance Scotland: www.alliance-scotland.org.uk
• Arthritis and Musculoskeletal Alliance: http://arma.uk.net/