RA and Cigarettes: A Dangerous Match

As if you needed another reason not to smoke, scientists have come up with yet another one: It turns out that smokers who receive treatment for early rheumatoid arthritis respond less vigorously than people who have never picked up a cigarette. Even former smokers achieve a better response than current smokers.

A 10-year study, conducted at Karolinska University Hospital and Karolinska Institute in Stockholm, Swedenlooked at data for 1,430 rheumatoid arthritis patients from ages 18 to 70, all of whom enrolled in clinical trials after being diagnosed. Twenty-seven percent were current smokers.The patients were given methotrexate or tumor necrosis factor inhibitors, common therapies for rheumatoid arthritis.

After three months on methotrexate, 36 percent of nonsmokers achieved a good response to treatment versus only 27 percent of smokers. The effects of tobacco were even more pronounced in the group taking tumor necrosis factor inhibitors: 43 percent of nonsmokers did well after three months, while only 29 percent of smokers did.

Interestingly, a past history of smoking did not seem to affect patients' responses to either therapy.

Not only does smoking interfere with rheumatoid-arthritis treatments, but past research has shown that smoking is itself a risk factor for the development and severity of the disease. A University of Iowa study questioned the smoking habits of 336 people with rheumatoid arthritis and found that people who had smoked over a long period of time were much more likely to be rheumatoid factor positive (rheumatoid factor is an autoimmune antibody that is strongly associated with a more severe course of the disease) and have more joint erosion than patients who had never smoked. A British study examined the records of thousands of Finnish children born in 1987 and determined that a mother's tobacco use during pregnancy increased the risk of juvenile rheumatoid arthritis in female children.

Since rheumatoid arthritis patients can suffer so much from the symptoms of the disease, it makes sense to put smoking cessation at the top of the treatment list. If you're a smoker with rheumatoid arthritis, talk to your doctor about getting help kicking the habit before you begin treatment. If you're already in treatment, remember that quitting smoking may help you respond to your medication more strongly.



American College of Rheumatologist, www.rheumatology.org

U.S. National Library of Medicine, www.ncbi.nlm.nih.gov