Smoking increases the risk of developing seropositive rheumatoid arthritis (RA) by 50% on average, and is associated with a reduced response to RA drug treatments. This talk will focus on 4 areas related to smoking cessation in RA patients. 1. A study of smoking in Scottish patients with RA and the impact of an RA and smoking cessation awareness campaign 2. Applying principles of Addictions Medicine in Rheumatology 3. Global trends in tobacco use 4. Presentation of a toolkit developed to enable Rheumatology teams to increase the quit rates of RA smokers. Only one in twenty Scottish RA patients questioned were aware of a link between RA and smoking. An RA and smoking public awareness campaign was launched in September 2011. Local media and online social networks reported the story and a mail drop was sent to RA patients. A marked improvement was found in patients’ knowledge about a link between RA and smoking. Smokers identified before the campaign were contacted again following the campaign and found to have modest changes in their attitudes to smoking. The reasons that some RA smokers were not planning to quit were cited as pleasure or relaxation in 24%. Almost 1 in 2 RA patients questioned were ex-smokers; most had used pharmacotherapy and 85% quit after 1-3 attempts. Experiencing a commonly known smoking related illness such as a chest infection was the commonest motivator to give up smoking in half of the RA ex-smokers. The Smoking and RA awareness campaign successfully increased patients’ knowledge of the link between RA and smoking and the effect of smoking on RA therapy. The study suggested that RA smokers may be motivated to quit by learning that RA is a smoking related disease. Nicotine addiction is a complex illnesscharacterized by intense and, at times, uncontrollable drug craving, along with compulsive drug seeking and use that persists even in the face of devastating consequences. Because addiction is typically a chronic disease, people cannot simply stop using nicotine for a few days and be cured. Most patients require long-term or repeated episodes of care to achieve the ultimate goal of sustained abstinence and recovery of their health. Scientific research since the mid–1970s has been used to develop principles that should form the basis of an effective nicotine addiction treatment program. These will be discussed in more detail expanding on their relevance to the RA smoker. Medication and behavioral therapy, especially when combined, are important elements of an overall therapeutic process that begins with smoking cessation, followed by treatment and relapse prevention. Tobacco use is the single most preventable cause of death globally and is currently responsible for killing one in 10 adults worldwide. Second-hand smoke accounts for one in 10 tobacco-related deaths. At present 11% of people are protected by comprehensive national smoke-free laws and 19 countries require large and graphic pictures on tobacco packages to warn people of the dangers. In countries where there is no tobacco control legislation, women are one of the biggest advertising targets of the tobacco industry. This is likely to have the consequence of increasing the incidence of RA in affected populations. In Europe, smoking levels among women vary significantly with the lowest smoking rates found in Nordic and some western European countries. The highest smoking rates in women are found in some central and southern European countries. Across Europe, the gender divide in smoking rates is narrower among young people. The tobacco industry has adapted its marketing techniques to take advantage of the differences between countries, and focused its efforts on girls. Bans on tobacco advertising, as called for in the WHO Framework Convention on Tobacco Control, could help to stop the increase in tobacco use among girls. In Scotland a toolkit has been launched to enable Rheumatology teams to improve quit rates in RA smokers. This includes a leaflet on how to deliver evidence-based brief advice on smoking cessation in 30 seconds. The tookit covers how to engage with the local smoking cessation team and advice on using pharmacotherapy. Rheumatologists need to engage in national efforts to reduce smoking rates by raising awareness of the increased risk of RA in smokers.
Disclosure of Interest H. Harris Consultant for: Pfizer, Savient. Paid instructor for: NAPP, MSD, Pfizer, BMS.