Ann Rheum Dis 1997;56:463-469 ( August )

Extended reports

Cigarette smoking and rheumatoid arthritis severity Kenneth G Saag,^a James R Cerhan,^c Sheela Kolluri,^c Kenjirou Ohashi,^d Gary W Hunninghake,^b David A Schwartz^b

^a Divisions of Rheumatology , ^b and Pulmonary, Critical Care and Occupational Medicine , ^c and Department of Preventive Medicine and Environmental Health , ^d the University of Iowa College of Medicine, Iowa City, Iowa, USA Department of Radiology Chigasaki Municipal Hospital, Chigasaki City, Kanagawa, Japan

Correspondence to: Dr K G Saag, Division of Rheumatology, Department of Internal Medicine, University of Iowa College of Medicine, Iowa City, Iowa, 52242-1087 USA.

Accepted for publication 1 May 1997

OBJECTIVESCigarette smoking may influence rheumatoid arthritis (RA) disease incidence and may have direct biological effects on the lungs and systemically. This study sought to determine if cigarette smoking is associated with RA disease severity.
METHODSClinical evaluations of patients seen in the University of Iowa rheumatology and orthopaedic ambulatory clinics were conducted. A letter of interest was mailed to 1701 patients who were first assigned an ICD-9-CM diagnostic code for RA in one of these clinics. A total of 857 patients expressed interest and were offered a clinical examination and 395 were evaluated over an 18 month period. Of these, 336 satisfied examiner criteria for prevalent RA and were included in the analysis. The disease characteristics and arthritis care utilisation of these patients seemed representative of prevalent cases in the general community. RA disease severity was assessed by radiographic bone erosions (graded as either present/absent and using the Larsen system), rheumatoid factor seropositivity, and presence of subcutaneous rheumatoid nodules.
RESULTSPack years of cigarette smoking was significantly associated with rheumatoid factor seropositivity (p = 0.0001), radiographic erosions (p = 0.024), and nodules (p = 0.051). After adjustment for potential confounders, smokers with 25 pack years were 3.1 times more likely to be rheumatoid factor positive (95% CI 1.7, 5.6) and 2.4 times more likely to show radiographic erosions (95% CI 1.2, 4.5) than never smokers. Less severe radiographic disease seemed to be more strongly associated with cigarette smoking than more severe disease.
CONCLUSIONCigarette smoking may adversely influence the severity of RA in a potentially dose dependent fashion.

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© 1997 by Annals of the Rheumatic Diseases
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