RESEARCH - Smoking intensity, duration, and cessation, and the risk of RA in women

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The American Journal of Medicine

Volume 119, Issue 6 , June 2006, Pages 503.e1-503.e9

Clinical research study

Smoking Intensity, Duration, and Cessation, and the Risk of Rheumatoid

Arthritis in Women

H. Costenbader MD, MPHa, b, , , Diane Feskanich ScDb, A. Mandl

MD, MPHc and W. Karlson MDa, b

aDivision of Rheumatology, Immunology, and Allergy, Section of Clinical

Sciences, B. Brigham Arthritis and Musculoskeletal Diseases Clinical

Research Center, Brigham and Women's Hospital, Harvard Medical School,

Boston, Mass

bChanning Laboratory, Department of Medicine, Brigham and Women's Hospital

and Harvard Medical School, Boston, Mass

cDivision of Rheumatology, Department of Medicine, Hospital For Special

Surgery, Cornell Weill Medical College, New York.

Abstract

Background

Cigarette smoking has been associated with rheumatoid arthritis (RA), but

the importance of smoking intensity, duration, and time since quitting, and

whether the risk is primarily for rheumatoid factor (RF) seropositive versus

seronegative RA are still unclear.

Methods

We conducted a prospective analysis of smoking and the risk of RA among

103,818 women in the Nurses' Health Study. A total of 680 RA cases,

diagnosed from 1976 and 2002, were confirmed using a questionnaire and

medical record review. Sixty percent were RF positive. proportional

hazards models calculated the relative risks (RRs) of RA with smoking,

adjusting for reproductive and lifestyle factors.

Results

The RR of RA was significantly elevated among current (RR 1.43 [95%

confidence interval 1.16-1.75]) and past smokers (RR 1.47 [95% confidence

interval 1.23-1.76]), compared with never smokers. The risk of RA was

significantly elevated with 10 pack-years or more of smoking and increased

linearly with increasing pack-years (P trend <.01). A greater number of

daily cigarettes and longer duration of smoking were associated with

increased risk. The effect of smoking was much stronger among RF-positive

cases than among RF-negative cases. The risk remained elevated in past

smokers until 20 years or more after cessation.

Conclusions

In this large cohort, past and current cigarette smoking were related to the

development of RA, in particular seropositive RA. Both smoking intensity and

duration were directly related to risk, with prolonged increased risk after

cessation.

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