RESEARCH - The effects of tobacco smoking and RF positivity on disease activity and joint damage in early RA

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Rheumatology (Oxford). 2006 Jun;45(6):734-40. Epub 2006 Jan 10.

The effects of tobacco smoking and rheumatoid factor seropositivity on

disease activity and joint damage in early rheumatoid arthritis.

Manfredsdottir VF, Vikingsdottir T, Jonsson T, Geirsson AJ, Kjartansson O,

Heimisdottir M, Sigurdardottir SL, Valdimarsson H, Vikingsson A.

Department of Medicine, Section of Rheumatology, Landspitali University

Hospital, 101 Reykjavik, Iceland. arnor@....

OBJECTIVE: To study the effect of tobacco smoking and rheumatoid factor (RF)

isotypes on disease activity and joint damage in early rheumatoid arthritis

(RA). METHODS: One hundred early RA patients were followed prospectively for

2 yr. They were evaluated at recruitment and at 6 and 24 months.

Sociodemographic information included smoking history, and radiographs of

hands and feet were obtained. RF was monitored by IgM- and IgA-specific RF

enzyme-linked immunosorbent assay and by agglutination, and serial

measurements were also obtained for C-reactive protein. The influence of

tobacco smoking and RF positivity on disease outcome was evaluated using

multivariate analysis. Covariates for the regression analysis included sex,

age, coffee consumption and IgA-RF positivity. RESULTS: A gradient of

increase in disease activity was observed from never smokers to former

smokers to current smokers during the 2 yr of observation, defined by number

of swollen joints (SJC), tender joints (TJC) and visual analogue scale for

pain (P<0.001, P=0.02 and P=0.005, respectively), but smoking status did not

influence radiological progression. Ever smokers were more often IgA RF

positive (P<0.05). IgA RF-positive patients had more active disease (SJC

P=0.002, TJC P=0.01) and showed more radiological progression (P<0.0001)

compared with IgA RF-negative patients. Of the RF-positive patients 22% had

elevated IgM RF without IgA RF and these patients showed similar disease

activity and radiological joint progression to the RF-negative patients.

None of these associations were explained by possible confounders.

CONCLUSION: Tobacco smoking has an adverse effect on patients with early RA

and this is possibly immunologically mediated. IgM RF does not predict

poorer prognosis in RA unless it is associated with a concomitant elevation

of IgA RF.

PMID: 16403829

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Retrieve & dopt=Abstra\

ct & list_uids=16403829

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