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/pubmed/16396705

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