Last year more evidence emerged that smoking worsens rheumatoid arthritis (RA) symptoms. Cigarette smoking has long been linked to several diseases, including diabetes, lung cancer, heart attacks and the onset of rheumatoid arthritis. Now we know it can also make the disease more severe.

Smoking and the Increased Risk of Developing Rheumatoid Arthritis

Smoking is the main environmental factor that increases the odds of developing rheumatoid arthritis, according to the American College of Rheumatology (ACR). In 2001, British researchers found that smoking increased the risk of developing rheumatoid arthritis when they analyzed the smoking habits of 239 patients with RA.

They found that patients were significantly more likely to be current smokers than healthy people. There was a 13-times higher risk of getting rheumatoid arthritis if the patient smoked 20 cigarettes a day for between 40 and 50 years. In addition, studies have shown that family history plays a role in developing RA. Yet, over half of the patients with RA had no family history of the disease.

However, some research shows there is an increased risk of developing ACPA-positive rheumatoid arthritis for people who smoke and have certain variations of the HLA-DRB1 gene. ACPA refers to anti-citrullinated protein antibodies that are used in diagnosing rheumatoid arthritis.

Smoking Worsens Several Rheumatoid Arthritis Symptoms

One of the other significant findings of the British study was that smoking increased the production of rheumatoid factor - a blood marker of rheumatoid arthritis. A subsequent study published in Rheumatology backed up this finding. Sixty-three women with advanced RA completed a questionnaire that included information about their smoking history.

Heavy smoking was associated with rheumatoid nodules, a higher HAQ (health assessment questionnaire) score, and lower grip strength. Smoking was also linked to radiological joint damage and an increase in rheumatoid factor levels. The researchers concluded that cigarette smoking was likely to have an adverse effect on how rheumatoid arthritis progresses.

Smoking Increases Cardiovascular Disease Risk in Rheumatoid Arthritis

According to the Arthritis Foundation, arthritis affects 57 percent of adults who have heart disease. If you have rheumatoid arthritis, your risk of developing heart disease is already much higher than the general population.

The medical community is still a bit in the dark about why RA makes heart disease worse. Several studies have shown that RA, which is an inflammatory condition, is an independent risk factor for heart disease. Despite this, doctors recommend that if you have rheumatoid arthritis, you should still try to actively address the traditional risk factors for cardiovascular disease (CVD), such as lowering blood pressure and cholesterol levels--and quitting smoking. You should also get regular cardiac tests as part of managing your rheumatoid arthritis.

Some medications such as methotrexate, glucocorticoids, leflunomide, sulfasalazine and TNF-alpha blockers seem to protect against heart disease. If you're not already taking one of these arthritis medications, speak to your rheumatologist, who will also be able to give you advice on other things you can be doing to reduce your risk of CVD, and smoking cessation plans.



Journal: Annals of Rheumatic Disease; Vol. 60 No. 3, pp. 223-227

Date: March 2001

Study: Heavy cigarette smoking is strongly associated with rheumatoid arthritis (RA), particularly in patients without a family history of RA.


Authors: D Hutchinson, L Shepstone, R Moots, J Lear, and M Lynch

Journal: Rheumatology Vol. 39, No. 11, pp. 1202-1205

Date: 2000

Study: Smoking, rheumatoid factor isotypes and severity of rheumatoid arthritis.


Authors: B. Másdóttir, T. Jónsson, V. Manfreðsdóttir, A. Víkingsson, Á. Brekkan1 and H. Valdimarsson