VIENNA, Austria - Smokers have more active rheumatoid arthritis (RA) than their nonsmoking counterparts, but quitting can help reduce disease activity, according to a new study1 presented here on Friday at the Annual European Congress of Rheumatology of the European League Against Rheumatism (EULAR) in Vienna, Austria.
An analysis of the Consortium of Research Rheumatologists in North America (CORRONA) database revealed that smokers had a significantly greater mean number of tender and swollen joint counts than nonsmokers. In addition, smokers were more likely to have higher levels of disease activity, to be taking a biologic agent, to be positive for rheumatoid factor (RF), and to have subcutaneous nodules. Current smokers also had more tender and swollen joints than previous smokers, suggesting that quitting can have positive effects on disease severity.
"We believe that this is the first observation that smokers are more likely to receive a biologic agent, lending support to payor programs, which reward nonsmoking," says lead researcher Lori Lavelle, MD, rheumatologist at the Albany Medical College in Albany, New York.
The new study comprised men and women examined between October 2001 to May 2005, and included 4414 nonsmokers, 954 present smokers (including 189 social smokers), and 1757 previous smokers.
Cytokine profile of smokers with RA elucidated
In a related presentation,2 researchers documented changes in both pro- and anti-inflammatory cytokines among smokers with RA. "This is not all that surprising, because people talk about how smoking can have anti-inflammatory effects on certain diseases such as inflammatory bowel disease," lead study author Ted R. Mikuls, MD, rheumatologist at the University of Nebraska Medical Center in Omaha tells CIAOMed. In this study, current smokers had serum cotinine values >100 ng/mL while nonsmokers had undetectable levels.
In smokers, interleukin (IL)-10, IL-1 receptor antagonist, soluble intercellular adhesion molecule-1 (sICAM1), and all RF isotypes were increased compared with nonsmokers. Smokers also had lower levels tissue inhibitor of metalloproteinase, the study showed.
"It didn't change tender and swollen joints, but our database was small," Dr. Mikuls tells CIAOMed. By contrast, Dr. Lavelle's study used "a powerful database, and so it had the ability to see pretty subtle associations."
"We should all be talking to our patients about stopping smoking and, maybe this starts to shed some light in the pathways involved in how smoking worsens disease," Dr. Mikuls tells CIAOMed.
References:
- Lavelle L, Reed G, Kremer JM. Effects of smoking on rheumatoid arthritis disease severity. Presented at: Annual European Congress of Rheumatology of EULAR; June 8-11, 2005; Vienna, Austria. Abstract OP0105.
- Mikuls TR, Snow MH, Rennard S, et al. The association of cigarette smoke exposure with serum cytokine expression and measures of disease activity in rheumatoid arthritis. Presented at: Annual European Congress of Rheumatology of EULAR; June 8-11, 2005; Vienna, Austria. Abstract OP0101.