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Study Shows it's Time for Smoking Cessation Counseling in RA

Smoking adversely affects flares and remission in rheumatoid arthritis patients shows a study that compared smoking and non-smoking patients.

Smoking adversely affects flares and remission in rheumatoid arthritis patients shows a study that compared smoking and non-smoking patients.

The study was presented on Nov. 14 at the American College of Rheumatology annual meeting in Washington, D.C., by Shafay Raheel, M.D., of Mayo Clinic.

The association between smoking and rheumatoid arthritis is well known, however, long term evidence linking smoking and rheumatoid arthritis flare activity is lacking.

Utilizing a population-based cohort model, the authors examined medical records of adults with rheumatoid arthritis in a retrospective manor. The records were reviewed for evidence of flare and remission events. Ultimately 650 patients were studied with mean follow up of 10.3 years.

Flare events represented 17% of the 17,323 clinical visits while remission visits accounted for 10%. It was found that active smokers had significantly more flare visits than non-smokers (p=0.047), while patients with rheumatoid arthritis who had quit smoking were no different than never smokers (p=.87). The data also suggested that early in the course of the disease flares were similar between smokers and non-smokers but over time smokers began having more flares.

Remission rates were greater for non-smokers than current smokers (p=-034) and again no difference with regards to remission visits was found between those who quit smoking and never smokers (p= 0.24).

This abstract brings light to an aspect of modifiable behavior that has a significant impact on the clinical course of rheumatoid arthritis. This long term follow up study makes clear associations between rheumatoid flares and remission among smokers that should lead to greater urgency in counseling patients about smoking cessation.

Consistent with what is know about smoking and rheumatoid arthritis incidence and mortality, this evidence accentuates those findings and can be used to provide patients who smoke with a solid way to improve their quality of life through behavior modifications rather than strictly pharmacologic means.

Key Points

  • Smoking is associated with more rheumatoid arthritis flare events and fewer periods of remission.
  • Quitting smoking brings the sufferer of rheumatoid arthritis on par with those who have never smoked with regards to flare and remission rates.
  • Many recent studies suggest that smoking cessation should be an integral part of treatment for rheumatoid arthritis patients who smoke.



“Smoking Is Associated with Unfavorable Flare/ Remission Pattern in Patients with Rheumatoid Arthritis,” Shafay Raheel. 2016 ACR/ARHP Annual Meeting. 2:30 p.m., Nov. 14, 2016. Abstract 1995.