Monday, 18 Feb 2019

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Smoking and Rheumatoid Arthritis

I read this recent article on smoking and rheumatoid arthritis (RA):  Smoking-related mortality in patients with early rheumatoid arthritis – a retrospective cohort study using the Clinical Practice Research Datalink by Rebecca Joseph, et al and have some thoughts.

What we know: Smoking increases morbidity and mortality for the general population. In RA, smoking is a risk factor (it increases RA risk, smokers get RA at an earlier age than non-smokers). Also, in RA, smokers may have worse RA outcomes – more joint damage, more are antibody positive (associated with worse disease), and smoking may clear a drug more quickly so smokers may have attenuated responses to many of their RA treatments.

What this article adds is that in a very large family practice database in the UK, more than 5600 patients with RA included 34% former and 26% current smokers. This would be higher than the expected population age and sex matched people (but this was not the scope of the article). What is showed was:  current smokers had more chance of dying, including cardiovascular disease and lung cancer but also all causes of death (overall), and those who stopped smoking had improved survival. Heavy smoking was worse on outcomes of survival than light smokers (so a dose response was found). 

All this would also occur in the general population, but what is really  important is that this is another reason to try to have our patients with RA quit smoking. 

This is a large well-conducted study without selection bias as the electronic medical records were used for all patients with RA in the large database. 

So, why do so many rheumatologists (including myself) not send our patients who smoke to smoking cessation programs or use aids for cessation? Do we think it is not our problem? I challenge all of us to take a detailed smoking history on all our patients over the next month and learn effective ways to encourage/facilitate smoking cessation.

This article will change my practice! It could change yours.

The author has no conflicts of interest to disclose related to this subject

Dr. Janet Pope is a Professor of Medicine in the Division of Rheumatology at the University of Western Ontario (UWO), Schulich School of Medicine, London, Ontario, Canada.  She is the Division Head in Rheumatology at St. Joseph's Health Centre, London. Her research includes studies in scleroderma, SLE and RA, including outcome measurements, clinical trials and disease manifestations. She has published over 450 peer-reviewed articles, 15 chapters, 500 abstracts and several Cochrane meta-analysis reviews. Mentoring of research students and trainees numbers more than 125. She has received the Distinguished Investigator Award from the Canadian Rheumatology Association, Rheumatologist of the Year from the Ontario Rheumatology Association, Department of Medicine Research Achievement Award, and the Dean’s Award of Excellence in Research. She has been inducted into the Canadian Academy of Health Sciences.


Rheumatologists' Comments

All my RA patients are baffled learning about these connections. Encouraging bit of information in that study to boost the motivation to sopt smoking: each year of cessation counts. Even the non smoker among our RA pts should be aware of the increased risk of developing RA in smokers so that they can inform their off spring to reduce their risk by stopping or never start smoking. Spread the message!
I fully agree. I forgot to ask if someone smokes after the initial visit and only remember if they smell like a smoker! Stop now and live longer. Their kids and sibs should be encouraged to Kick the Habit.