New research shows that smoking may reduce the potency of antirheumatic drugs and increase the severity of symptoms among rheumatoid arthritis (RA) patients who are rheumatoid factor (RF) positive, but smoking does not seem to worsen joint damage. The findings appear in the journal Rheumatology.
"The higher use of disease modifying antirheumatic drugs (DMARDs) may indicate that smoking weakens the potency of antirheumatic drugs and/or is needed to control an otherwise higher disease activity."?Gisela Westhoff, MD"The higher use of disease modifying antirheumatic drugs (DMARDs) may indicate that smoking weakens the potency of antirheumatic drugs and/or is needed to control an otherwise higher disease activity," conclude researchers led by Gisela Westhoff, MD, of the German Rheumatism Research Centre in Berlin. "Since the risk of adverse events increases with the amount of drugs taken, this is another reason to persuade RA patients to quit smoking," Dr. Westhoff said.
The researchers looked at baseline and 3-year follow-up data from 896 patients of an early RA cohort to determine the influence of smoking on disease activity, drug usage, and X-ray joint damage in RF-positive and -negative patients with early RA (disease duration of <24 months).
Smokers with RA need more medications
Overall, 50% of the patients never smoked, 23% were past smokers, and 27% were current smokers. Current smokers were significantly more often RF-positive (71%) than past (66%) or never smokers (53%), but neither RF-positive nor -negative current smokers had higher 28-joint disease activity score or radiographic scores than never or past smokers, the study showed.
Current smokers had taken significantly more DMARD combinations or biologics within 3 years. Nonsmokers and those with <20 pack-years had a twofold higher probability of achieving American College of Rheumatology improvement than heavy smokers with >20 pack-years. There was no difference seen in radiographic joint damage between smokers and nonsmokers of the same serological group.
"We can ascertain from our study that smoking is associated with RF positivity, disease severity, and higher drug use," the researchers conclude.
Translating research into practice
The article "does serve as a talking point for ongoing conversations with our RA patients who smoke," said Ted R. Mikuls, MD, from the University of Nebraska Medical Center, the Nebraska Arthritis Outcomes Research Center, and the Omaha VA Medical Center. "With literally thousands of toxins in cigarette smoke, the impact that smoking has in RA may be quite complex," he told MSKreport.com. "It's certainly plausible to think that tobacco smoke exposure may impact drug potency both directly and indirectly by stimulating inflammation in a nonspecific manner."
"I personally think of cigarette smoking as a comorbidity in itself in my RA patients, a condition that like hypertension or diabetes must be managed and treated," he said. "Obviously quitting smoking is no easy task so it requires both patience and persistence and a 'game plan' for both the patient and provider."
The advent of newer smoking cessation tools available today may help certain RA patients quit. Dr. Mikuls emphasized a successful cessation plan must be specifically tailored for every patient. “It's important for the RA patient to understand that smoking cessation is really important, given what we know not only in RA, but in how smoking impacts other disease states including cancer risk and cardiovascular disease."
Reference
1. Westhoff G, Rau R, Zink A. 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. Rheumatology. 2008;47:849-854.
good posty lynn .. alllthough every ailment is nowlinkedto smoking
I would think that smoking can increase inflammation.
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