Another Reason to Quit: Smoking and Back Pain

Smoking may worsen treatment response in axial spondyloarthritis

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

(RxWiki News) Of all the parts of the body smoking can damage, the back doesn't seem like it would be one of them. Many smokers with lower back arthritis, however, may beg to differ. Smokers with this condition may not respond as well to treatment as nonsmokers.

That's the takeaway from a new study from Swiss researchers. The authors of this study said they didn't know why smoking may have this effect.

Axial spondyloarthritis (AxSpA) is the medical term for inflammatory arthritis of the lower back. Back pain is the most common symptom of AxSpA, according to the Spondylitis Association of America. Unlike other rheumatic diseases, it may not show up on X-rays for many years, if at all. An MRI may show inflammation around the sacroiliac joints — the joints between the tailbone and pelvis.

The research team, led by Dr. Adrian Ciurea, of the Department of Rheumatology at University Hospital Zurich in Switzerland, noted that smoking is known to increase the risk of rheumatoid arthritis (RA). Smokers with RA often don’t respond as well to some of the medication used to treat this disease. However, the current study was the first to look specifically at AxSpA and smoking.

To assess the effect of smoking on AxSpA, Dr. Ciurea and team studied almost 500 patients who were known to have the condition between 2005 and 2014. Sixty-two percent of the patients in this study were smokers.

Other factors like age, sex, weight, exercise and how long a patient has had symptoms may affect patients’ response to treatment. Dr. Ciurea and colleagues accounted for all of these factors, but current smokers still didn’t respond to treatment as well as nonsmokers.

Dr. Ciurea and team used standard scoring methods to determine what effect treatment had on patients’ symptoms. These scores included such factors as low back pain, exercise tolerance and morning stiffness.

After a year of treatment, only 10 percent to 20 percent of current smokers reported a significant decrease in symptoms. People who were not current smokers were much more likely to report symptom relief.

Dr. Ciurea and colleagues also noted that people who smoked and had high C-reactive protein (CRP) levels to begin with were even less likely to respond to treatment. CRP is a measure of inflammation in the body.

Unlike current smokers, former smokers did not show any differences in treatment response.

This study was published Feb. 9 in the Annals of the Rheumatic Diseases.

Several Swiss organizations and pharmaceutical companies like AbbVie, Merck and Pfizer funded this research. Study authors Dr. Ulrich Weber, Dr. Ciurea and Dr. Exer disclosed financial ties to AbbVie, Merck and Pfizer, among others.

Review Date: 
February 8, 2015
Last Updated:
February 10, 2015