Background Tobacco smoking is an important modifiable environmental risk factor in the development and disease activity of autoimmune rheumatic disease including rheumatoid arthritis (RA), systemic lupus erythematous, systemic sclerosis and antiphospholipid syndrome. In RA the risk is two-fold in ever vs never smokers1, appears to be dose related2 and correlated to severe extra-articular disease3. Response to disease-modifying antirheumatic drugs and tumour necrosis factor inhibitors is also decreased in smokers4.
Objectives This pilot study is to assess awareness of the negative impact of smoking on rheumatic disease and establish the methods by which previous smokers achieved long-term abstinence.
Methods 100 patients (median age 55 years) in a rheumatology outpatient setting were asked to complete a questionnaire relating to smoking history. Surveys were distributed over a two month period. Rheumatological diagnosis, comprehensive smoking history and awareness of the negative impact of smoking on rheumatic disease was established. Ever-smokers (those having smoked >100 cigarettes or equivalent over their lifetime) were specifically questioned whether they had received information regarding smoking and rheumatological disease burden, or cessation advice directly from healthcare professionals. Methods to achieve smoking abstinence was also established.
Results 34/49 individuals completing the questionnaire met inclusion criteria. 17/34 (50%) identified themselves as current or former smokers and of this population only 8/17 (47%) were aware of the negative association of smoking and rheumatological disease. All current smokers said they would like to stop, with the majority 4/7 (57%) stating health reasons as the impetus to do this. Of ever-smokers 7/17 (41%) had received cessation advice from a healthcare professional, 3/17 (18%) stated this was from a rheumatologist. The majority of former smokers 8/10 (80%) abstained without pharmaco- or behavioural therapies and 9/10 (90%) felt they would be unlikely or very unlikely to restart. Of current smokers 3/7 (43%) had previously tried to stop, 2/7 (29%) had attempted on 10 or more occasions using 3 or more therapies. Only e-cigarettes were deemed a beneficial adjuvant in smoking cessation.
Conclusions This survey highlights the need for enhanced patient education regarding the risks of smoking in rheumatalogical disease.
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Di Giuseppe D, Discacciati A, Orsini N, Wolk A. Cigarette smoking and risk of rheumatoid arthritis: a dose-response meta-analysis. Arthritis Res Ther. 2014;16(2).
Nyhall-Wahlin, BM, Petersson, IF, Nilsson, JA, Jacobsson, LT, and Turesson, C. High disease activity disability burden and smoking predict severe extra-articular manifestations in early rheumatoid arthritis. Rheumatology (Oxford). 2009; 48: 416–420.
Saevarsdottir S, Wedren S, Seddighzadeh M et al. Patients with early rheumatoid arthritis who smoke are less likely to respond to treatment with methotrexate and tumor necrosis factor inhibitors: observations from the Epidemiological Investigation of Rheumatoid Arthritis and the Swedish Rheumatology Register cohorts. Arthritis Rheum. 2011;63:26–36.
Disclosure of Interest None declared
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