RESEARCH - Does cigarette smoking influence disease expression, activity and severity in early RA?

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Clin Exp Rheumatol. 2005 Nov-Dec;23(6):861-6.

Does cigarette smoking influence disease expression, activity and severity

in early rheumatoid arthritis patients?

Papadopoulos NG, Alamanos Y, Voulgari PV, Epagelis EK, Tsifetaki N, Drosos

AA.

Rheumatology Clinic, Department of Internal Medicine, Medical School,

University of Ioannina, Ioannina, Greece.

OBJECTIVE: To investigate the association of cigarette smoking with clinical

expression, disease activity and severity in a cohort of Greek patients with

early rheumatoid arthritis (RA). METHODS: From January 1993 until December

2002, 293 patients with early RA were diagnosed and followed up in our

rheumatology clinic. All patients fulfilled the American College of

Rheumatology criteria for RA, had disease duration of less than one year,

without prior treatment of disease modifying anti-rheumatic drugs (DMARDs)

or steroids. The patients were treated with at least one DMARD, and 287 of

them had a last follow up during the year 2004. The demographic, personal,

clinical, laboratory, radiological and therapeutic features were compared at

entry and at the last follow-up, according to their smoking habits at entry.

RESULTS: Among the 293 patients, 6 were lost to follow-up, thus 287 patients

were evaluated. There were 200 females (67.7%) and 87 males (30.3%).

Eighty-two (28.6%) were current smokers, 21 (7.3%) ex-smokers and 184

(64.1%) non-smokers at presentation. RA smoker patients displayed the

disease at a younger age than the non-smokers. Additionally, the smokers

presented at disease onset more prominent features of articular involvement

as was evaluated by the higher number of total joint count with tenderness

and swelling and by the higher disease activity for 28 joint indices score

(DAS-28). Smokers also presented a higher Larsen's score and higher

frequency of IgM and IgA rheumatoid factors as compared to non-smokers. At

the end of the study, the smoker patients presented more active and severe

disease as evaluated by the higher total number of tender and swelling joint

count, the higher DAS-28, and higher Larsen's score as compared to

non-smokers. Furthermore, the smokers more frequently had rheumatoid nodules

than the ex-smokers and non-smokers. The association of smoking with disease

activity and severity was independent of sex, age, educational level,

alcohol consumption, and follow-up duration. Finally, no significant

differences were observed concerning the therapeutic procedure among the

three groups.

CONCLUSIONS: In our early RA patients, cigarette smoking was associated with

increased disease activity, and severity, independently of several other

possible confounders and despite the early disease treatment.

PMID: 16396705

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

ct & list_uids=16396705

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