In a new study, researchers evaluated the relationship between rheumatoid arthritis (RA) risk and smoking in a cohort of women. They discovered that quitting smoking may significantly lower the odds of developing seropositive RA.
“Our study is one of the first to show that a behavior change of prolonged smoking cessation may actually delay or even prevent the onset of seropositive RA, suggesting lifestyle changes may modify risk for development of a systemic rheumatic disease,” said senior author Dr. Jeffrey Sparks, of Brigham and Women’s Hospital, in a press release.
The study authors used data from the Nurses’ Health Study (NHS, 1976–2014) and the NHSII (1989–2015). Biennial questionnaires provided smoking exposures and covariates, and RA was self-reported and confirmed via medical records.
RA and Smoking: Seropositive Versus Seronegative
Of 230,732 total women, 1,528 had incident RA, of whom most (63.4%) were seropositive. Current smokers, compared to never smokers, had increased odds of all RA (multivariable HR 1.47, 95%CI 1.27‐1.72) and seropositive RA (HR 1.67, 95%CI 1.38‐2.01), but there was no significant risk for seronegative RA (HR 1.20, 95%CI 0.93‐1.55). A trend was also observed for increasing smoking pack-years and increased risk for all RA (p<0.0001) and seropositive RA (p<0.0001). Women who quit smoking earlier reduced their risk for all RA (p=0.009) and seropositive RA (p=0.002). Women who quit smoking at least three decades previously had a lower hazard ratio (HR) for seropositive RA compared to women who quit within the last five years (HR 0.63, 95%CI 0.44‐0.90), but even 30 years later, researchers still observed an increased risk for RA (all RA: HR 1.25, 95%CI 1.02‐1.53; seropositive RA: HR 1.30, 95%CI 1.01‐1.68; reference: never smoking).
Dr. Brittany Bettendorf and colleagues @UWMadison found significant benefit in a new smoking cessation protocol for people with #rheumatoidarthritis. Their results were published in a recent issue of Arthritis Care & Research. https://t.co/5S2NJjLN82 pic.twitter.com/vBWmLmGN5M
— Internal Medicine at Iowa (@IntMedatIowa) February 18, 2019
What Prevents Patients from Quitting?
A separate study sought to determine what barriers exist for quitting smoking among rheumatic disease patients.
“Although smoking is a risk factor for cardiovascular and rheumatic disease severity, only 10% of rheumatology visits document cessation counseling,” the study authors wrote.
For this study, researchers included 19 smokers, of whom 12 had RA and seven had systemic lupus erythematosus (SLE). Patients were stratified to one of three semi-structured focus groups. The study authors found that roadblocks for cessation were multi-faceted and included psychological, health, and social and economic factors, as well as healthcare messaging and resources. Patients identified smoking as “a crutch” while dealing with their rheumatic disease. They also cited little cessation counseling in the rheumatology setting. There was also a lack of awareness that smoking adversely impacts rheumatic disease and certain treatments.
“Two key outcomes of improving cessation care for patients with RA and SLE were knowing why and how to quit,” the researchers observed. Emphasizing rheumatologic health benefits and cessation resources are essential when designing and evaluating rheumatology smoking cessation interventions.”
Both studies were published in Arthritis Care & Research.
Source: Arthritis Care & Research: Impact and timing of smoking cessation on reducing risk for rheumatoid arthritis among women in the Nurses’ Health Studies; Patient Perspectives on Smoking Cessation and Interventions in Rheumatology Clinics;