Stopping Smoking May Cut RA Pain, Disease Activity

ORLANDO, Florida, and SAN FRANCISCO, California—Smoking reduces the efficacy of chronic pain treatment in men, and stopping smoking can reduce rheumatoid arthritis (RA) disease activity in both sexes, according to experts at two recent medical meetings.

At the 2008 American Society of Anesthesiologists (ASA) meeting, W. Michael Hooten, MD, from the Mayo Clinic College of Medicine in Rochester, Minnesota, reported that smokers with RA who quit smoking had lower swollen and tender joint counts and lower C-reactive protein (CRP) levels, than similar patients who continued to smoke.¹ In related work, Hooten et al also found that baseline morphine doses and pain scores were twice as high for smokers as for never-smokers.²

“This tells you something clinically important almost as soon as you walk into the exam room where there is a patient who is a smoker,” Dr. Hooten told MSKreport.com. “If you yourself don't smoke, you can nearly always smell traces of smoke on a patient who does. And that gives you the information that if the patient is a man with a chronic pain condition, the opioid requirement is likely to be greater. In RA patients who smoke, there is likely to be greater impairment in physical function.”

Dr. Hooten's study was intended to determine whether smoking status and gender affect the success of pain rehabilitation that incorporates opioid tapering. The retrospective study assessed outcomes in a consecutive series of 1241 chronic pain patients (75% women) admitted to a 3-week, pain treatment program. Outcome measures were the Multidimensional Pain Inventory, SF-36, Center for Epidemiologic Studies-Depression Scale and the Pain Catastrophizing Scale.

Smoking prevalence was 28% among men and 24% among women.

“We found that, in patients undergoing treatment for chronic pain in a 3-week outpatient program, measures of physical functioning were higher in women than men, and that smoking status affected these measures in men, but not women. These results suggest that sex is an important determinant of opioid use and functional status in patients undergoing treatment for chronic pain, and that the effects of smoking status on functional outcomes may be limited to men,” Dr. Hooten reported. He told MSKreport.com that his group will extend these studies to assess the effects of smoking cessation on patients with chronic pain.

Related work that will be reported at the 2008 American College of Rheumatology meeting shows that smoking cessation can have a major effect on RA signs and symptoms.³

Mark C. Fisher, MD, MPH, of NYU-Hospital for Joint Diseases in New York, examined the impact of smoking cessation over a 2-year period in a retrospective study of 14,847 patients enrolled in an RA registry. The researchers defined smoking cessation as patient-reporting cessation of smoking over two consecutive visits. The primary outcome was change in Clinical Disease Activity Index (CDAI) as a continuous variable. Secondary outcomes were tender (T) and swollen (S) joint counts (JC) and mHAQ.

Among 1405 smokers enrolled into the registry, 21.1% (297) managed to quit. Dr. Fisher reported that at the last follow-up visit, those who had quit smoking had

lower CDAI than active smokers (10.5 vs 13.4, P <.0001)
lower SJC (P <0.01)
lower TJC (P <0.01), and
lower CRP (P <0.01).

“After controlling for other potential confounders in a regression model, continuation of smoking (vs smoking cessation) was associated with an increase in CDAI score (coefficient 0.42, CI 0.15 - 0.69, P = .003),” the researchers reported. “To our knowledge, this is the first study demonstrating a reduction in disease activity measures among RA patients who stop smoking.”

“While these results are preliminary, it seems that quitting smoking, which would have many other health benefits, also may benefit patients with rheumatoid arthritis,” Dr. Fisher commented.

References

1. Hooten WM, Townsend CO, Warner DO. Sex differences in treatment outcomes among smokers with chronic pain. Presented at: American Society of Anesthesiologists 2008 annual meeting; October 18, 2008; Orlando, FL. Presentation A401.
2. Hooten WM, Townsend CO, Warner DO. Effects of smoking status on opioid tapering among patients with chronic pain. Presented at: American Society of Anesthesiologists 2008 annual meeting; October 18, 2008; Orlando, FL. Presentation A405.
3. Fisher MC, El-Taha M, Kremer JM, et al. Smoking cessation and improvement of RA disease activity. Presented at: American College of Rheumatology 2008 annual meeting; October 27, 2008; San Francisco, CA. Presentation 1188.

Keep hoping...I was ecstatic to find out that red wine reduced inflammation............

Stopping Smoking May Cut RA Pain, Disease Activity | Arthritis Information