Strategies to reduce the impact of smoking on rheumatoid arthritis outcomes: Clinical experience of a brief outpatient clinic screening questionnaire. Comment on “The impact of smoking on rheumatoid arthritis outcomes.” By Vittecoq et al. Joint Bone Spine 2018;85:135–138

A systematic review with meta-analysis of the effects of smoking cessation strategies in patients with rheumatoid arthritis

“…Among the 18 studies included in the review, 10 studies were reported in abstract format ( Table 1 ). Three studies were randomized controlled trials [ 37 , 46 , 58 ], and the rest were nonrandomized studies: 10 were uncontrolled trials (same participants evaluated at baseline and follow-ups) [ 42 , 44 , 47 , 48 , 50 – 54 , 59 ], and 5 were implementation studies (different participants evaluated before and after implementation of the intervention) [ 38 – 41 , 45 ]. Sample sizes ranged from 20 to 970.…”

“…There were 6 types of interventions targeting patients: 1 study reporting on a social marketing campaign [ 45 ]; 3 reporting on a health education intervention alone [ 44 , 51 , 52 ], 1 reporting on health education combined with nicotine replacement therapy (NRT) [ 48 ], 3 reporting on health education combined with NRT plus counseling sessions [ 37 , 50 , 54 ], 1 reporting on counseling sessions alone [ 47 ], and 4 reporting on lifestyle education focused on cardiovascular risk with goal setting [ 43 , 46 , 53 , 56 , 59 ]. There were 2 types of interventions targeting providers: 3 studies (18%) reported using electronic health record prompts to assess smoking status and offer training on how to refer to Quit line support services [ 38 – 40 ], and 1 study reported using a screening questionnaire to assess smoking status to offer referrals [ 41 ].…”

“…Two implementation studies with different participants assessed an intervention for providers before and after implementation [ 39 , 41 ]. The pooled rate of current tobacco users was lower in the post-implementation population at 6 months (15%; 95% CI: 13% to 18%) than in the pre-implementation population (20%; 95% CI: 18% to 21%) ( S4 Table ).…”

“…For one implementation study with different participants assessed before and after intervention and unspecified follow-up, the mean (± SD) number of cigarettes smoked per day was similar in the post-implementation period and the pre-implementation period (7 ± 4 vs. 8 ± 5, respectively) [ 41 ].…”