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Ann Rheum Dis 69:70-81 doi:10.1136/ard.2008.096487
  • Clinical and epidemiological research
  • Extended report

Impact of smoking as a risk factor for developing rheumatoid arthritis: a meta-analysis of observational studies

  1. D Sugiyama1,
  2. K Nishimura2,3,
  3. K Tamaki4,
  4. G Tsuji1,
  5. T Nakazawa1,5,
  6. A Morinobu1,
  7. S Kumagai1,2
  1. 1
    Department of Clinical Pathology and Immunology, Kobe University Graduate School of Medicine, Kobe, Japan
  2. 2
    Department of Evidence Based Laboratory Medicine (Sysmex), Kobe University Graduate School of Medicine, Kobe, Japan
  3. 3
    Department of Health Policy Management, Harvard School of Public Health, Boston, Massachusetts, USA
  4. 4
    Department of Respiratory Medicine, Kansai Electric Power Central Hospital, Osaka, Japan
  5. 5
    Department of Rheumatology, Kurashiki Central Hospital, Okayama, Japan
  1. Correspondence to Dr S Kumagai, Department of Clinical Pathology and Immunology, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan; kumagais{at}kobe-u.ac.jp
  • Accepted 13 January 2009
  • Published Online First 27 January 2009

Abstract

Objectives: To assess whether smoking is a risk factor for developing rheumatoid arthritis (RA).

Design: Meta-analysis.

Method: Data sources were observational studies that examined the association between smoking history and the risk of developing RA identified through Medline and EMBASE (from 1966 to December 2006), relevant books and a reference search. Two authors independently extracted the following: authors’ names, publication year, sample size, participant characteristics, odds ratios (OR) or relative risks, adjustment factors, study design and area where the study was conducted. Data syntheses were based upon random effects model. Summarised syntheses effects were expressed by OR.

Results: Sixteen studies were selected from among 433 articles. For men, summary OR for ever, current and past smokers were 1.89 (95% CI 1.56 to 2.28), 1.87 (1.49 to 2.34) and 1.76 (1.33 to 2.31), respectively. For rheumatoid factor-positive (RF+) RA, summary OR for ever, current and past smokers were 3.02 (2.35 to 3.88), 3.91 (2.78 to 5.50) and 2.46 (1.74 to 3.47), respectively. Summary OR for 20 or more pack-years of smoking was 2.31 (1.55 to 3.41). For women, summary OR for ever, current and past smokers were 1.27 (1.12 to 1.44), 1.31 (1.12 to 1.54) and 1.22 (1.06 to 1.40), respectively. For RF+ RA, summary OR for ever, current and past smokers were 1.34 (0.99 to 1.80), 1.29 (0.94 to 1.77) and 1.21 (0.83 to 1.77). Summary OR for 20 or more pack-years of smoking was 1.75 (1.52 to 2.02).

Conclusion: Smoking is a risk factor for RA, especially RF+ RA men and heavy smokers.

Footnotes

  • ▸ Additional supplemental file is published online only at http://ard.bmj.com/content/vol69/issue1

  • Funding DS is supported by a Hyogo Science and Technology Association grant 18D022.

  • Competing interests None.

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