RESEARCH - Cigarette smoking associates with body weight and muscle mass of patients with RA

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Arthritis Research & Therapy 2008, 10:R59doi:10.1186/ar2429

Research article

Cigarette smoking associates with body weight and muscle mass of

patients with rheumatoid arthritis: a cross-sectional, observational

study

s Stavropoulos-Kalinoglou1,2,3 , Giorgos S Metsios1,2,3 ,

Vasileios F Panoulas3 , MJ 3 , Alan M Nevill1,2 ,

Athanasios Z Jamurtas4,5 , Marina Kita3 , Yiannis Koutedakis1,4,5 and

D Kitas2,3,6

1School of Sport, Performing Arts & Leisure, Wolverhampton University,

Gorway Road, Walsall, WS1 3BD, West Midlands, UK

2Research Institute in Healthcare Science, University of

Wolverhampton, Wulfruna Street, Wolverhampton, WV1 1LY, West Midlands,

UK

3Department of Rheumatology, Dudley Group of Hospitals NHS Trust,

's Hall Hospital, Pensnett Road, Dudley, DY1 2HQ, West

Midlands, UK

4Department of Sport and Exercise Science, University of Thessaly,

Trikala-Karyes Road, Trikala, 42100, Greece

5Institute of Human Performance & Rehabilitation, Trikala-Karyes Road,

Trikala, 42100, Greece

6ARC Epidemiology Unit, University of Manchester, Oxford Road,

Manchester, M13 9PT, UK

Abstract

Introduction

Rheumatoid arthritis (RA) is associated with altered metabolism

leading to muscle wasting. In the general population, cigarette

smoking is known to affect body composition by reducing fat and

inhibiting muscle synthesis. Even though smoking has been implicated

in the pathophysiology and progression of RA, its possible effects on

body composition of such patients have not been studied. This

cross-sectional study aimed to identify potential associations of

smoking with body weight and composition of RA patients.

Methods

A total of 392 patients (290 females) with RA were assessed for body

mass index (BMI), body fat (BF), fat-free mass (FFM), and waist

circumference. Erythrocyte sedimentation rate, C-reactive protein,

Disease Activity Score-28, and Health Assessment Questionnaire score

were used to assess disease activity and severity. Smoking habit

(current smoker, ex-smoker, or never-smoker) and intensity

(pack-years) were also noted.

Results

Current smokers had a significantly lower BMI compared with ex-smokers

(mean difference: male -2.6, 95% confidence interval [CI]: -3.5 to

-1.7; female: -2.6, 95% CI: -4.8 to -0.5) and never-smokers (mean

difference: male -1.8, 95% CI: -3 to -0.6; female: -1.4, 95% CI: -2.4

to -0.4). Similarly, the BF of current smokers was lower compared with

that of ex-smokers (mean difference: male: -4.3, 95% CI: -7.5 to -1.2;

female: -3.4, 95% CI: -6.4 to -0.4) and never-smokers (mean

difference: male: -3.3, 95% CI: -6.3 to -0.4; female: -2.1, 95% CI: -4

to -0.2). FFM did not differ between groups. Finally, current smokers

had a significantly smaller waist circumference compared with

ex-smokers only (mean difference: male: -6.2, 95% CI: -10.4 to -1.9;

female: -7.8, 95% CI: -13.5 to -2.1). Following adjustments for age,

disease duration, and HAQ score, smoking remained a significant

predictor for BMI (P < 0.001), BF (P < 0.05), and waist circumference

(P < 0.05). Pack-years were inversely correlated with BF (r = -0.46; P

< 0.001), and heavy smokers exhibited a significantly lower FFM (P <

0.05) compared with all other participants.

Conclusion

Within the limitations of a cross-sectional study, it appears that

cigarette smoking associates with reduced BMI and BF in patients with

RA and heavy smoking associates with lower muscle mass. Smoking

cessation appears to associate with increased BMI, BF, and waist

circumference in these patients. These results should be confirmed in

prospective studies. Given the numerous adverse effects of smoking on

general health and RA, patients should be actively advised against it.

However, smoking cessation regimes in RA may need to include more

general lifestyle counselling, particularly about weight control.

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http://arthritis-research.com/content/10/3/R59

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