Cigarettes May Worsen Arthritis

Rheumatoid arthritis and spondyloarthritis patients who smoke had increased inflammation after pneumococcal vaccination

/ Author:  / Reviewed by: Robert Carlson, M.D

(RxWiki News) Smoking cigarettes and drinking alcohol are two vices that can take a toll on your health in a variety of ways. More specifically, these habits may worsen certain types of arthritis.

After receiving pneumococcal conjugate vaccine (a vaccine to prevent pneumococcal disease), smoking may increase inflammation and weaken immune response in patients with rheumatoid arthritis or spondyloarthritis (arthritis of the spine).

Drinking low to moderate amounts of alcohol (less than 30 grams per day) was linked to fewer signs of inflammation in these patients.

"Quit smoking today!"

In autoimmune diseases like rheumatoid arthritis and ankylosing spondylitis, the immune system mistakenly attacks healthy joints and tissues, leading to inflammation. Inflammation is what leads to the pain and swelling in these diseases.

In their recent study, Meliha Kapetanovic, MD, PhD, of Lund University, and colleagues wanted to see how cigarette smoking and alcohol drinking habits affected inflammation in patients who had been vaccinated for pneumococcal disease - a condition that can lead to pneumonia, blood infection, middle ear infection and other health problems.

Pneumococcal vaccine is recommended to everyone 65 years of age and older. The vaccine is also recommended to anyone under 65 years with chronic conditions like inflammatory arthritis.

Smoking has been linked to both pneumococcal disease and inflammatory arthritis.

Drinking too much alcohol has been shown to put people at risk of various infections, particularly lung infections.

Dr. Kapetanovic and colleagues set out to study the effects of smoking and drinking on inflammation in arthritis patients taking different kinds of medications.

They studied six different groups:

  • rheumatoid arthritis patients on methotrexate and, in some cases, other disease-modifying anti-rheumatic drugs (DMARDs)
  • rheumatoid arthritis patients on anti-TNF drugs alone
  • rheumatoid arthritis patients on anti-TNF drugs, methotrexate and possibly other DMARDs
  • spondyloarthritis patients on anti-TNF drugs alone
  • spondyloarthritis patients on anti-TNF drugs, methotrexate, and possibly other DMARDs
  • spondyloarthritis patients on non-steroidal anti-inflammatory drugs (NSAIDs) and/or analgesics

A total of 88 out of 505 (17.4 percent) were current smokers.

Smokers had higher C-reactive protein (CRP) levels and a higher erythrocyte sedimentation rate (ESR). Both CRP and ESR are blood tests that measure levels of inflammation.

Smokers had lower levels of IgG (an antibody made by the immune system to fight harmful invaders that is also involved in causing autoimmune disease). Smokers also had a lower immune response (level of antibodies before vaccination versus after vaccination).

Rheumatoid arthritis patients on methotrexate who smoked at least one pack per year had a lower immune response than those who never smoked.

Drinking alcohol was linked to fewer signs of inflammation, with lower levels of CRP and ESR. However, drinking alcohol did not affect immune response or IgG levels.

According to the authors, these findings about drinking alcohol are in line with other studies showing that low to moderate alcohol consumption may protect against inflammation and heart problems.

In conclusion, the authors said the strongest effect of smoking was seen in rheumatoid arthritis patients taking methotrexate alone. Among these patients, smoking was identified as a sign of a weakened immune response after pneumococcal vaccination.

"Both smoking and alcohol consumption had an impact on systemic inflammation: smoking being associated with higher and alcohol with lower levels of inflammatory markers," the authors said.

"Our results contribute to the growing evidence of negative effects of smoking and possible advantage of moderate alcohol drinking in patients with established arthritis," they said.

This study received support from the Swedish Rheumatism Association, the Swedish Research Council, the Medical Faculty of Lund University, the Alfred Österlund Foundation, the Crafoord Foundation, the Greta and Johan Kock Foundation, King Gustaf V's 80-Year Foundation and Lund University Hospital.

The research was published July 23 in Arthritis Research & Therapy.

Reviewed by: 
Review Date: 
August 8, 2012
Last Updated:
May 7, 2013