Background Smoking is known to be a modifiable risk factor for the development of seropositive rheumatoid arthritis (RA). It contributes 25% of the population burden of RA. Those who are smokers are less likely to respond to methotrexate1 and are more likely to fail anti TNF2 with a reduction of response to rituximab3. Although the prevalence of smoking is well known in early arthritis (25%)4 smoking in established rheumatoid arthritis is less well characterized.
Objectives This study looks at smoking in an established cohort of RA patients.
Methods All RA patients testing positive for ACPA from 2010-2013 and all RA patients receiving aTNF treatment from 2008-2013 were contacted. 265 patients were included in the study. Patients were contacted by telephone and asked about their smoking history and efforts in cessation of smoking.
Results 178 patients took part in the survey, (178/265, 67.2%) the remaining patients were non contactable, deceased or refused participation. 76% were Caucasian, 12% Asian, 8% AfroCaribean. Average age was 58 and 74% were female.15% (26/178) were smokers. The mean age of smokers was 57.6 years and the mean pack year history was 21.1. The majority of smokers were Caucasian (20/26, 75%). The majority of current smokers were male. 85% had tried to quit, 81% had been asked by their doctor about smoking, 73% had been asked to stop smoking but only 46% had been given support smoking.
Conclusions 15% of the rheumatoid arthritis population were smokers. The known prevalence of smoking in the general population is 21.2%. A review of the effectiveness of NHS smoking cessation services in 2009 demonstrated quit rates of 53% at 1 month and 15% at 1 yr5. Offering very brief smoking cessation advice is the single most cost effective and clinically proven preventative action a healthcare professional can take. Rheumatology outpatients may be an ideal opportunity to support patients to give up smoking and improve their disease prognosis. It's time to Ask, Advise and Act on smoking.
Westhoff G, Rau R, Zink A. Rheumatoid arthritis patients who smoke have a higher need for DMARDs and feel worse, but they do not have more joint damage than non-smokers of the same serological group. Rheumatology (Oxford). 2008;47(6):849-54.
Mattey DL, Brownfield A, Dawes PT. Relationship between pack-year history of smoking and response to tumor necrosis factor antagonists in patients with rheumatoid arthritis. J Rheumatol. 2009;36(6):1180-7.
Khan A, Scott DL, Batley M. Smoking, rheumatoid factor status and responses to rituximab. Ann Rheum Dis. 2012;71(9):1587-8.
Breedveld FC, Weisman MH, Kavanaugh AF, et al. The PREMIER study: A multicenter, randomized, double-blind clinical trial of combination therapy with adalimumab plus methotrexate versus methotrexate alone or adalimumab alone in patients with early, aggressive rheumatoid arthritis who had not had previous methotrexate treatment. Arthritis Rheum. 2006;54(1):26-37.
Bauld L, Bell K, McCullough L, Richardson L, Greaves L. The effectiveness of NHS smoking cessation services: a systematic review. J Public Health (Oxf). 2010;32(1):71-82.
Disclosure of Interest None declared