Impact of smoking as a risk factor for developing rheumatoid arthritis: a meta-analysis of observational studies

Sugiyama, Daisuke; Nishimura, Kunihiro; Tamaki, Kenichiro; Tsuji, Goh; Nakazawa, Takashi; Morinobu, Akio; Kumagai, Shunichi

doi:10.1136/ard.2008.096487

Cited by 544 publications

(430 citation statements)

References 57 publications

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“…Researchers found that in rheumatoid-factor-positive RA men, heavy smoking was a significant risk factor for RA: odds ratio 3.91, 95% CI 2.78 -5.50. 26 Specific studies on the association of RA-BR with smoking are lacking, but in fact the limited data available suggest that patients with RA-BR are more likely to be non-smokers, compared to those with RA alone. 15,27,28 Thus, from the available literature there is no evidence to implicate smoking in the association of RA and BR.…”

Section: Risk Factors Smokingmentioning

confidence: 99%

Coexistence of Bronchiectasis and Rheumatoid Arthritis: Revisited

2013

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The presence of bronchiectasis (BR) in patients with rheumatoid arthritis (RA) has been recognized for many decades; nevertheless, little research has been undertaken in this area. It is important to recognize that BR coexistent with RA differs from the other types of BR. The purpose of this descriptive review was to delineate the epidemiology, etiology, risk factors, pulmonary function testing, imaging, prognosis and management of concomitant BR and RA. To inform our study we searched the PubMed, EMBASE, CINAHL, and MEDLINE databases, using combinations of the following key words: computed tomography, lung function tests, rheumatoid arthritis, bronchiectasis, biological agents, and interstitial lung disease. The number of published papers covering this topic is limited, but several relevant conclusions can be drawn. Patients with concomitant RA and BR have worse obstructive airways disease, increased susceptibility to recurrent pulmonary infections, faster lung function decline, and higher mortality, compared with subjects with either RA or BR alone. The use of disease-modifying anti-rheumatic drugs (both biological and non-biological) for RA in RA-BR patients imparts a further challenge in managing these patients. Although there are not any published guidelines on the management of coexisting RA-BR, we have attempted to provide such recommendations, based on the literature review and our experience.

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Section: Risk Factors Smokingmentioning

confidence: 99%

Coexistence of Bronchiectasis and Rheumatoid Arthritis: Revisited

2013

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“…Furthermore, in a meta-analysis of 16 studies on patients that smoked, it was identified that male smokers exhibited a summary OR of 1.87 (95% CI, 1.49-2.34) for developing RA and a summary OR of 3.91 (95% CI, 2.78-5.50) for positive rheumatoid factor. Furthermore, the same meta-analysis demonstrated that female smokers had respective OR values of 1.31 (95% CI, 1.12-1.54) and 1.29 (95% CI, 0.94-1.77) (40). Thus, smoking was a greater risk factor for developing RA in males compared with females, illustrating another similarity between Chikungunya fever and RA.…”

Section: Discussionmentioning

confidence: 74%

Smoking and female sex as key risk factors associated with severe arthralgia in acute and chronic phases of Chikungunya virus infection

Delgado‐Enciso

Paz‐Michel²,

Melnikov

et al. 2017

Exp Ther Med

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Abstract. Arthralgia is a potentially incapacitating condition and a persistent symptom in chronic or acute episodes of Chikungunya fever caused by infection with the Chikungunya virus (CHIKV). To the best of our knowledge, there are no reports on risk factors associated with the intensity of arthralgias in typical acute episodes of the disease. Although a number of studies have reported on risk factors associated with the development of the chronic stage of the disease, smoking habits have not been analyzed. Smoking is an interesting factor to consider since it is the main environmental risk factor for the development of rheumatoid arthritis (RA), a similar disease to CHIKV in many aspects. In the present study, 140 patients infected with CHIKV were assessed for risk factors associated with severe arthralgia intensity in the acute phase (pain of 9/10 on the visual analog scale of 0-10) and moderate to severe intensity (according to the Routine Assessment of Patient Index Data 3) 3.5 months after infection in patients that experienced the chronic phase of the disease. Women and smokers were 2-to 3-times more likely to experience severe pain in the acute and chronic stages. Likewise, the presence of severe arthralgia during the acute disease phase resulted in a 4-fold increased risk for entering the chronic phase. Smoking was a more important risk factor in males compared with females. Smoking resulted in a 20-fold increased risk for severe arthralgia during the acute phase in men, as well as a 10-fold increased risk for developing chronic disease with moderate-to-severe pain 3.5 months after the acute stage. The presence of rash, headache, muscular weakness or conjunctivitis in the acute phase, the presence of diabetes and age >40 years were considered significant risk factors due to their influence on illness progression. In conclusion, smoking and female sex were the main risk factors associated with development of severe joint pain in the acute and chronic phases of Chikungunya fever. These risk factors are similar to those associated with the development and severity of RA, possibly because the two diseases share pathophysiological mechanisms, including elevated interleukin-6 levels.

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“…Cigarette smoking is recognized as an important risk factor for RA development and is associated with increased risk of comorbidities that are leading causes of death in RA, including cardiovascular and respiratory diseases (5)(6)(7)(8)(9)(10). Smoking cessation at any time after RA diagnosis was associated with decreased mortality risk in a recent large study in the UK (11).…”

Section: Introductionmentioning

confidence: 98%

Smoking Behavior Changes in the Early Rheumatoid Arthritis Period and Risk of Mortality During Thirty‐Six Years of Prospective Followup

Chang

Nguyen

Barbhaiya

et al. 2017

Arthritis Care & Research

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Objective. To investigate whether rheumatoid arthritis (RA) diagnosis influences smoking behavior changes and whether these changes were associated with mortality. Methods. We identified an incident RA cohort in the Nurses' Health Study (NHS; 1976-2012. Behavioral data were collected through biennial questionnaires. We created a comparison cohort, matching RA cases to women without RA by age and calendar year at the index date of RA diagnosis. To investigate smoking behavior changes in the early RA period, sustained cessation was defined as permanently quitting within 4 years of the RA/index date. We used Cox regression to obtain hazard ratios (HRs) for mortality, comparing sustained smoking cessation to continued smoking. Results. Among 121,700 women in the NHS, we identified 938 with incident RA matched to 8,951 non-RA comparators. Among current smokers, 40.0% with RA permanently quit smoking in the early RA period, compared to 36.1% of comparators (odds ratio for sustained cessation 1.18 [95% confidence interval (95% CI) 0.88, 1.58]). There were 313 deaths (33.4%) in the RA cohort and 2,042 (22.8%) among comparators. Compared to continued smoking, sustained cessation was associated with similarly decreased mortality in both the RA (HR 0.58 [95% CI 0.33, 1.01]) and comparison (HR 0.47 [95% CI 0.39, 0.58]) cohorts. Women with RA had higher mortality for >5 post-RA pack-years (HR 3.67 [95% CI 2.80, 4.81]) than comparators with >5 post-index pack-years (HR 1.88 [95% CI 1.62, 2.17]; P < 0.001 for interaction; reference: ever-smoker non-RA women with 0 post-index pack-years). Conclusion. Sustained smoking cessation within 4 years of RA diagnosis reduced mortality risk, with a similar effect observed among non-RA comparators. Smoking >5 pack-years after RA diagnosis significantly increased mortality beyond the risk of non-RA comparators.

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Impact of smoking as a risk factor for developing rheumatoid arthritis: a meta-analysis of observational studies

Abstract: Smoking is a risk factor for RA, especially RF+ RA men and heavy smokers.

Cited by 544 publications

References 57 publications

Coexistence of Bronchiectasis and Rheumatoid Arthritis: Revisited

Coexistence of Bronchiectasis and Rheumatoid Arthritis: Revisited

Smoking and female sex as key risk factors associated with severe arthralgia in acute and chronic phases of Chikungunya virus infection

Smoking Behavior Changes in the Early Rheumatoid Arthritis Period and Risk of Mortality During Thirty‐Six Years of Prospective Followup

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