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Dear Dr. Cush, As regarding to stopping smoking and the effect of it on RA disease activity, we have published an article in a large Swedish RA cohort of 1460 RA patients, of which 127 patients stopped smoking. The patients who stopped smoking had a poorer prognosis. The study was a retrospective cohort study. Please see: Andersson ML, Bergman S, Söderlin MK. The effect of stopping smoking on disease activity in RA. Data from BARFOT, a multicenter study in RA. Open Rheumatology J. 2012;6:303-9. The article is open access. Yours sincerely, Maria Söderlin, MD, PhD

According to literatures in a multi-cohort study revealed that smoking by ACPA leads to joint damage .Comparison of radiological progression in cohorts of RA patients ( with according to smoking status never, past and current as well as ACPA status) detected progression remarkably more severe joint damage in smokers .Ann Rheum Dis. 2014;73:1384-1387.