Smoking and RA

by Wendy McBrair, MS, BSN, CHES

Smoking and RA

It wasn’t long ago that smoking was considered sophisticated, a helpful source of energy, and good for weight control. Movies made in the 1940’s through the 1960’s habitually featured at least one character smoking and enjoying it. Kids smoked behind closed doors or in cars thinking it was “cool.” Parents smoked without worrying about secondhand smoke or whether they were being poor role models for their children. And smokers with rheumatoid arthritis (RA) likely never gave a thought to whether there was a connection between their condition and their habit.

We are all a lot wiser now. We know what smoking tobacco, and even being exposed to secondhand smoke, can do to our health. It is well established that smoking contributes to problems with the heart, blood vessels, and lungs and also raises the risk for some cancers, osteoporosis, and blindness. Furthermore — although this is not so widely known — smoking is now considered a risk factor for developing RA.

Because smoking’s role is not well known, people tend to focus on other risk factors for RA, such as having a close family member with the condition or being a woman (women are twice as likely as men to develop RA). But these are facts we can’t change. Being a smoker is something we can change. And quitting smoking offers a proven way to reduce the risk of developing RA and might also help reduce the impact of RA that has already developed. This article looks first at the evidence for a connection between RA and smoking, and then describes steps you can take to help yourself quit.

What do the studies reveal?

Multiple studies have come to the same conclusion: people who smoke are more likely to get RA, and their RA is more likely to be severe.

In a study published in 2005 in Clinical and Experimental Rheumatology, 287 people newly diagnosed with RA were followed for 10 years. The study found that those who smoked were diagnosed with RA at an earlier age, had more joints affected by RA, and had more active RA. They also had more joint damage as seen on x-rays than nonsmokers. The study concluded that people with RA who smoke are at higher risk for more active and severe RA. Other, more recent studies have come to similar conclusions. One study found that smokers with RA tend to use more disease-modifying antirheumatic drugs (DMARDs) and biologic drugs. According to the study’s authors, this might mean that smoking reduces the potency of these drugs, that the smokers’ RA is more active, or both.

Why does smoking increase RA risk? Research suggests that there is a genetic connection. In a Swedish study published in the October 2004 issue of Arthritis & Rheumatism, researchers tested the DNA of 858 people newly diagnosed with RA and 1,048 people who did not have RA. The participants included both smokers and people who had never smoked (never-smokers). The study focused on a gene linked to RA called the shared epitope (SE) HLA-DR gene. The researchers found that smokers who had two copies of the SE HLA-DR gene were 15.7 times more likely than never-smokers without the gene to have RA. Smokers with one copy of the gene were 7.5 times more likely to have RA. Never-smokers with the gene were only 2.8 times more likely to have RA. Smoking, according to this study, seemed to trigger a preexisting genetic disposition to RA.

Recently, researchers have begun looking into whether quitting smoking can reduce RA symptoms in people who already have RA. A study presented at the 2008 American College of Rheumatology Annual Scientific Meeting found that stopping smoking could help control the symptoms of RA. In the study, researchers at three major medical centers in New York State evaluated 14,847 people with RA. Of the 1,405 who were smokers when they entered the study, 21.1% were able to quit. At the end of the study, those who had stopped smoking had fewer swollen and tender joint counts and lower blood levels of C-reactive protein (a protein that is associated with inflammation) than those who continued smoking. However, there was no difference between the two groups in other measures, such as DMARD and biologic use. The evidence from the study is preliminary, but it suggests that quitting smoking may have a positive effect on RA symptoms.

Getting ready to quit

No matter what the state of your health, quitting smoking will help improve it. But even when you’re armed with this knowledge, stopping is far from easy. The good news is that there are proven methods to help you quit.

As with any major behavior change, quitting smoking requires that you first understand completely what needs to be changed. Smoking cigarettes is not only a habit; it can also be an addiction. Because they contain nicotine, cigarettes can be as addictive as cocaine and heroin. Nicotine enters the body through the lungs as smoke is inhaled, travels quickly through the bloodstream to most body parts, and there causes both a physical and mental dependence. Nicotine stays in your body for at least three to four days after your last smoke. Because it invades so much of your body and takes such a strong hold, stopping smoking often requires more than just a strong will.

Last Reviewed on May 30, 2012

Wendy McBrair spent 30 years as a health-care professional in the fields of rheumatology and orthopedics, where she specialized in patient and community service, patient education, and advocacy.

Statements and opinions expressed on this Web site are those of the authors and not necessarily those of the publishers or advertisers. The information provided on this Web site should not be construed as medical instruction. Consult appropriate health-care professionals before taking action based on this information.

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