RESEARCH - RA patients who smoke have a higher need for DMARDs and feel worse, but they do not have more joint damage than non-smokers of the same serological group

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Rheumatology (Oxford). 2008 Jun;47(6):849-54. Epub 2008 Apr 4.

Rheumatoid arthritis patients who smoke have a higher need for DMARDs

and feel worse, but they do not have more joint damage than

non-smokers of the same serological group.

Westhoff G, Rau R, Zink A.

Epidemiology Unit, German Rheumatism Research Centre Berlin,

Charitéplatz 1, 10117 Berlin, Germany.

OBJECTIVES: To investigate the influence of smoking on disease

activity, drug need and radiographic joint damage in RF-positive and

-negative patients with early RA.

METHODS: Baseline and 3-yr follow-up data of 896 patients of an early

RA cohort comprised clinical and radiographic parameters (Ratingen

Score). Information about disease severity, treatment and smoking were

obtained by questionnaires. Univariate and multivariate analyses were

used to show the influence of smoking on drug use, ACR improvement and

joint damage. Smokers and non-smokers were compared according to RF

serology.

RESULTS: Fifty per cent of the patients were never, 23% past and 27%

current smokers. Current smokers were significantly more often

RF-positive (71%) than past (66%) or never smokers (53%), but neither

the RF-positive nor the RF-negative current smokers had higher

28-joint disease activity score (DAS28) or radiographic scores than

never or past smokers. Within 3 yrs, current smokers had taken

significantly more DMARD combinations or biologics. Non-smokers and

those with <20 pack-years (PYs) had a 2-fold higher probability to

reach ACR improvement than heavy smokers (>20 PYs). However, smokers

did not differ in radiographic joint damage when compared with

non-smokers of the same serological group.

CONCLUSIONS: The higher use of DMARDs may indicate that smoking

weakens the potency of anti-rheumatic drugs and/or is needed to

control an otherwise higher disease activity. Since the risk of

adverse events increases with the amount of drugs taken, this is

another reason to persuade RA patients to quit smoking.

PMID: 18390589

http://www.ncbi.nlm.nih.gov/pubmed/18390589

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