Smoking May Worsen RA

Rheumatoid arthritis patients who smoke have higher disease activity than nonsmokers

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) Smoking hurts your lungs, there's no doubt about it. But smoking is bad for you in so many other ways, especially if you have rheumatoid arthritis.

Smoking may worsen rheumatoid arthritis in patients taking anti-tumor necrosis factor (anti-TNF) drugs.

"Quit smoking today!"

If doctors knew how smoking affected arthritis treatment, they could discuss smoking with their patients and encourage them to quit.

So, in a recent study, Ozlem Pala, MD, of the University of Miami, and colleagues set out to see how smoking could affect patients' response to anti-TNFs, a class of drugs commonly prescribed to people with rheumatoid arthritis.

"There have been several studies which have investigated factors affecting response to anti-TNFs, but this is the first study to investigate response factors in such a large cohort of people," says Dr. Pala.

"Being able to better predict response rates to treatment means that rheumatologists can discuss the findings with their patients who smoke and strongly encourage them to quit. This may also motivate them to develop successful strategies for smoking cessation in order to maximize effect of this expensive group of medications and potentially increase quality of life for these patients," she says.

To study the effects of smoking on rheumatoid arthritis treatment, Dr. Pala and colleagues used the Clinical Disease Activity Index (CDAI) and DAS28 (Disease Activity Score) - two ways to measure disease activity in rheumatoid arthritis. DAS28 assesses patient's number of tender or swollen joints out of 28, ESR (a blood marker of inflammation), and "global assessment of global health."

Like DAS28, CDAI measures the number of tender or swollen joints out of 28, but does not require lab tests. For both measurements, a higher score indicates more disease activity.

The study's results show that smokers on anti-TNF drugs had higher disease activity than non-smokers.

At the beginning of the study, both smokers and non-smokers had similar DAS28 scores. However, smokers had higher CDAI scores at the start of the study.

These findings add to evidence that smoking has a negative impact on treatment response in rheumatoid arthritis patients.

The study included 2,811 rheumatoid arthritis patients just beginning anti-TNF treatment. Of these patients, 19 percent were smokers and 81 percent were non-smokers.

The results were presented at the 2012 Annual Congress of the European League Against Rheumatism. As such, the study has yet to be assessed by a peer-reviewed academic journal. 

Reviewed by: 
Review Date: 
June 11, 2012
Last Updated:
October 23, 2012