Maiden et al raise a number of important and interesting points in their paper “Does social disadvantage contribute to the excess mortality in rheumatoid arthritis patients?”1

They have observed that mortality in rheumatoid arthritis (RA) correlated with social grouping on the west coast of Scotland. Patients with RA of the lowest socioeconomic classes have an increased mortality when compared with patients of a higher socioeconomic class. Moreover, RA was more prevalent in patients with RA of lower socioeconomic class. We propose that these two important observations can both be explained by cigarette smoking.

The authors commented that cigarette smoking was more prevalent in the patients with RA of lower socioeconomic class in their study. In Britain there is a marked difference in smoking prevalence between social classes. In the 1996 census 41% of lower social class men (social class 4) were current smokers, with only 12% of men in the highest social class (social class 1) currently smoking.2Cigarette smoking kills 120 000 people a year in Britain.3 Most of these deaths are as a result of cardiovascular disease, respiratory disease, and lung cancer. Maidenet al 1 observed that 65% of the deaths in their study occurred as …