Worse Spondylitis May Be New Reason to Kick the Habit

Ankylosing spondylitis patients who smoked had more bone and joint damage than nonsmokers

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) There are many reasons to quit smoking, and people with ankylosing spondylitis can add another to the list.

Recently, researchers looked at the effects of smoking on the development of ankylosing spondylitis, a type of arthritis that causes bone growth and fusion of the spine.

They found that smoking led to significantly more bone and joint damage, especially among patients who were young men.

The researchers suggested that quitting smoking could be especially important for people with ankylosing spondylitis.

"Talk to your doctor about quitting smoking."

Sofia Ramiro, MD, of the Academic Medical Center at the University of Amsterdam in the Netherlands, led this study to see how smoking affected the severity of ankylosing spondylitis, a type of arthritis.

Ankylosing spondylitis is an inflammatory disease that can lead to extra bone growth and fusion of the vertebrae in the spine. As the vertebrae fuse, upper body movement becomes limited and patients tend to hunch over.

Patients with ankylosing spondylitis also commonly report pain and stiffness, especially in the hips, lower back, ribs and shoulder joints.

Young men are more likely to have ankylosing spondylitis than women or older people. Although there are no cures, certain medical treatments can relieve the pain and stiffness that patients often experience.

This study examined whether smoking also affected symptoms of ankylosing spondylitis. The researchers examined data from the Outcome in Ankylosing Spondylitis International Study, or OASIS.

A total of 127 patients participated in this study, and the researchers followed up with them periodically over 12 years. Most of the patients were male and had an average age of 41. They had been diagnosed an average of 18 years prior to the study.

The researchers examined levels of inflammation in the participants through a physical exam, x-rays, the patients' evaluation of their disease and measures of levels of a protein in the blood that indicate inflammation.

The patient data was used to assess the relationship between inflammation and the progression of bone and joint damage in the years that followed.

The team of researchers found that, compared with nonsmokers, smoking was associated with about 5.5 times more damage caused by inflammation seen on x-rays.

Also, men who had been diagnosed with the disease more recently were especially sensitive to increased inflammation due to smoking.

Smoking in males had 13.4 times higher effect of inflammation on damage than was seen in women who were nonsmokers.

The researchers concluded that smoking amplified the progression of ankylosing spondylitis, especially for men with the disease.

They suggested that smoking cessation, especially for young men, may result in less spinal damage.

“This study reaffirms what we have always told our patients, that smoking is deleterious to the spine and accelerates arthritic degeneration," Neel Anand, MD, Clinical Professor of Surgery and director of spine trauma at Cedars-Sinai Spine Center, told dailyRx News.

"Not only does smoking cause our bones to degenerate rapidly and severely, it can also have a host of terrible consequences (like too much blood loss) during surgery. This study adds to the volume of data out there that strongly suggests that smoking is detrimental to our health,” said Dr. Anand, who was not involved in this study.

"We often hear of how unhealthy smoking is for our hearts, but it isn't often discussed how harmful the habit is to our bones and discs," Dr. Anand said.

"Smoking hinders the ability of our bones to stay strong and re-grow when they break. When it comes to situations where surgical intervention is required to fix degenerated bones — spinal fusion surgery for example — if bones are already weak due to prolonged cigarette usage, sometimes even the most gifted surgeon is unable to get them to fuse back together properly, or help them stay fused for the long haul. It also has been implicated with accelerated degeneration of the disc and delayed or non-union when fusions are done," he said.

"In addition to the problems that smoking can cause during surgery for a patient, it can also be responsible for major complications after surgery. By way of what it does to our whole body, smoking weakens the immune system. After surgery is when we want our immune system to be in its best working order because it helps us fight off infection and recover more quickly and completely. When immune systems are compromised, we surgeons see many more infections and healing times that are increased far longer than they should be,” he said.

This research will be presented on October 28 at the annual meeting for the American College of Rheumatology.

The researchers disclosed no conflicts of interest or funding sources.

Review Date: 
October 24, 2013
Last Updated:
December 30, 2013