Background It is known that smoking is a poor prognostic factor for the development of rheumatoid arthritis (RA) and other inflammatory rheumatic diseases. According to our knowledge in Turkish population there are no studies about effects of smoking on joint damage and disease activity of RA patients.

Objectives In this study, we investigated the relationship between smoking with disease activity and radiological damage in Turkish patients with RA.

Methods The study included 165 patients with RA. Patients' demographics, disease duration, age at onset, drugs, rheumatoid factor (RF) levels, anti- Cyclic Citrullinated Peptide (a- CCP) levels and smoking habits recorded. Morning stiffness duration, tender and swollen joint count (TJC, SCJ), pain with using visual analog scale (VAS pain), patient and physician global assessment (PGA, PhGA), Health assessment questionnaire (HAQ) evaluated. Disease activity score 28 (DAS 28) calculated. All patients in the study examined for lung involvement and 127 patients standard hand radiographs evaluated using modified Sharp method.

Results Mean disease duration was 139.4±96.4 months. Patients were divided into 3 groups according to smoking habits. Ninety nine (60%) patients were never smoker, 45 (27.3%) patients were long-term smoker (more than 2 years), and 21 (12.7%) patients were new smoker (2 or less years). While the groups were similar in terms of age and disease duration, male gender was more in long-term smokers. Three groups compared for disease activity. DAS 28 scores were 3.2±1.2; 3.2±1.3; 3.2±1.4 respectively (p>0.05). The erosion score (2.6±5.8; 7.1±10.9; 11.1±19.2 respectively) and joint space narrowing score (9.9±7.3; 18.6±14.9; 17.3±12.3 respectively) according to modified Sharp method were significantly lower in never smokers group than other groups (p<0.05). RF titrations were 55.2±58.9; 84.9±71.5; 60.5±63.1; and long- term smokers group was significantly higher than the other groups (p<0.05). Likewise RF titration was higher in ≥20 pack-years smokers than the other patients (never smokers and <20 pack-years smokers). There was no relationship between a-CPP levels with smoking and joint damage (p>0.05).

Conclusions Although smoking known as a poor prognostic factor in RA, there was no correlation between disease activity and smoking in our population. On the other hand, less radiographic damage has been found in never smoker group. Although cigarette smoking does not appear to correlate with disease activity may be effective in the long-term joint damage.

Disclosure of Interest None declared