Increased inflammation and disease activity among current cigarette smokers with rheumatoid arthritis: a cross-sectional analysis of US veterans

Abstract

Objectives. Cigarette smoking is a major risk factor for RA and has been associated with increased disease severity and lower rates of disease remission. We hypothesized that inflammation and disease activity would be associated with smoking status and this would be related to levels of ACPA.Methods. RA patients from the Veterans Affairs RA registry were studied (n = 1466): 76.9% anti-CCP2 positive, 89% male, median age 63 years (interquartile range 5772), median disease duration 8.45 years (interquartile range 2.818). Baseline serum samples were evaluated for levels of anti-CCP2, RF, 19 distinct ACPAs and 17 cytokines. Smoking status at baseline was recorded as current, former or never. The association of smoking status with cytokines, autoantibodies and disease activity (DAS28) was evaluated.Results. Among anti-CCP-positive RA patients, RA-associated cytokines (false-discovery rates q < 0.1%) and DAS28 (P < 0.01) were higher in current smokers compared with former or never smokers. DAS28 and cytokine levels were similar between former and never smokers. In contrast, ACPA concentrations were higher among both current and former smokers compared with never smokers, and levels of ACPA were not associated with DAS28 or cytokine levels.Conclusion. Among anti-CCP2-positive RA patients, current smoking status is associated with elevations in pro-inflammatory cytokines and increased RA disease activity. Similar levels of inflammation and disease activity among former and never smokers suggests that the detrimental effects of smoking could be ameliorated through tobacco cessation. The effect of tobacco cessation on RA disease activity should be evaluated prospectively.

Increased cardiovascular risk in rheumatoid arthritis: mechanisms and implications

“…Finally, as a shared risk factor for rheumatoid arthritis and cardiovascular disease,11 smoking cessation is critical in reducing cardiovascular risk. This intervention may also pay dividends in terms of rheumatoid arthritis disease activity, as smoking has been linked to increased disease activity and inflammation 171172. Similarly, comorbid conditions adversely affecting cardiovascular risk, including hypertension, diabetes, and chronic kidney disease, should be aggressively treated.…”

Konservative Therapie rheumatischer Erkrankungen

“…Die aus der Erfahrungsmedizin erwachsenen konservativen Therapien hingegen finden nur selten den Weg ins Bewusstsein der Bevölkerung. Auch die Hilfe zur Selbsthilfe, wie die Diätberatung, Suchtberatung und die Beratung hinsichtlich sportlicher Belastungen sowie beruflicher und Freizeitaktivitäten stellt einen zentralen, wenn auch häufig vernachlässigten Punkt zur Verbesserung der Lebensqualität dar (3)(4)(5)(6)(7)(8).…”

Can smoking cessation interventions reduce disease activity in persons with chronic autoimmune inflammatory diseases? A Cochrane Review summary with commentary

“…Tobacco smoking is considered an environmental risk factor for developing RA 3 and appears to have negative effects on disease activity, pain, and health-related QoL (HRQoL) in people with IJD. 4,5 Smoking causes suppression of the immune system, specifically the pulmonary immune response 6 and also causes oxidative stress in the body. 7 Rehabilitation is an essential component of IJD treatment; rehabilitation aims to assist patients to achieve their highest level of functioning and independence and improves their overall QoL.…”