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THU0578-HPR Wide-Spread Pain and Pain Intensity in Patients with Early Rheumatoid Arthritis. A Comparison between Smokers and Non- Smokers. A Cross-Sectional Study
  1. M.-L. Karlsson1,
  2. A.-C. Elkan2,
  3. I. Hafström1
  1. 1Rheumatology Unit, Karolinska University Hospital
  2. 2Rheumatology Unit, Department of Learning, informatics, management and ethics, Stockholm, Sweden


Background Pain is a frequent symptom in patients with rheumatoid arthritis (RA). In patients with established RA about 34% had wide-spread pain more than three months and pain was more likely present in smokers than non-smokers [1]. Also in populations without inflammatory joint disease smokers had more spread pain and fibromyalgia than non- smokers [2]. However, there are few studies comparing pain intensity between smokers and non-smokers in early RA, and there were no studies exploring if smoking status is associated with difference in wide-spread pain.

Objectives The aim of this cross-sectional study was to investigate if smoking status at time for diagnosis of RA was associated with pain spread or pain intensity, and if pain was associated with disease activity

Methods In all 78 consecutive patients (59 women), median (IQR) age 63 (52-72) years, who received a diagnosis of RA for the first time and fulfilled the ACR classification criteria were included. They were all of Caucasian ancestry and recruited from the day care unit at the Rheumatology department Karolinska University Hospital Huddinge from January 2012 to February 2013.

The patients answered questions about smoking habits and were registered as current smoker (n=16), previous smokers (n=23) (those who had smoked sometime during the last 30 years) and never smokers (n=39). Previous and never smokers were categorized as non-smokers. Widespread pain was captured with body mankin and defined as pain both in the left and right side of the body as well as both above and below the waist. Pain intensity was measured by visual analogue scale (VAS, 0-100 mm).

Results There was no significant difference between smokers and non-smokers regarding age, RF- and anti-CCP-positivity, disease duration or disease activity measured by DAS28. Smokers had less frequent wide-spread pain, 56%, compared with non-smokers 82%, p=0.028, but pain intensity did not differ between smoking groups, smokers VAS median 46 (IQR 25-74) versus non-smokers VAS median 43 (IQR 14-67) mm. Disease activity (DAS28) was positively associated with pain intensity, r=0.45, but did not differ between those who experienced wide-spread pain or not.

Conclusions In this study smoking status did not influence pain intensity but possibly affected pain spread. The difference between smoking-groups in wide-spread pain might be explained by the nicotine analgesic property [3]. Probable smoking may help smokers to distract themselves from pain. To confirm these results, additional studies on larger patient material are warranted.


  1. Andersson ML, Svensson B, Bergman S. Chronic Widespread Pain in patients with Rheumatoid Arthritis and the relation between pain and disease activity measures over the five first years. J Rheumatol.2013 Dec;40 (12) 1977-85

  2. John U, Hanke M, Meyer C, Volzke H, BauDec;40(12):1977-85meister SE, Alte D: Tobacco smoking in relation to pain in a national general population survey. Preventive medicine 2006, 43(6):477-481.

  3. Shi Y, Weingarten TN, Mantilla CB, Hooten WM, Warner DO: Smoking and pain: pathophysiology and clinical implications. Anesthesiology 2010, 113(4):977-992.

Disclosure of Interest : None declared

DOI 10.1136/annrheumdis-2014-eular.2118

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