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Dissociation Between Rheumatoid Arthritis Markers And Joint Damage Among Smokers
A DGReview of :"The association of cigarette smoking with disease outcome in patients with early inflammatory polyarthritis"
Arthritis & Rheumatism
03/22/2001
By Mark Greener
Smokers are more likely to develop nodules and be positive for rheumatoid factor, but show similar levels of radiological damage and fewer swollen joints than do non-smokers.
Smoking cigarettes increases levels of rheumatoid factor and promotes nodule formation among patients with rheumatoid arthritis (RA). However, any impact on disease outcomes is less well characterised.
Against this background, researchers from the University of Manchester, United Kingdom, examined the influence of smoking on disease outcomes over three years in 486 patients with inflammatory polyarthritis.
Sixty-seven per cent of patients satisfied the American College of Rheumatology criteria for RA. Researchers assessed smoking status at baseline and disease outcomes after three years by assessing joint inflammation, functional disability and radiological damage.
Forty-seven percent of current smokers were positive for rheumatoid factor at baseline compared to 34 and 31 percent among ex- and never smokers respectively. After three years, 13 percent of smokers developed rheumatoid nodules compared to 4 percent of ex- and never smokers. After adjusting for age and sex, smokers were more than four-fold (odds ratio 4.07) times more likely to develop rheumatoid nodules than ex- and never smokers.
In contrast, after adjusting for age and sex, current smokers had fewer swollen joints (odds ratio 0.61). Smoking status did not appear to be associated with either the development of erosions or functional disability.
The authors conclude that smokers are more likely to develop nodules and be positive for rheumatoid factor than ex- and never-smokers. Despite this, current smokers did not show greater radiological damage. Indeed, current smokers had fewer swollen joints than ex- and never smokers.
The authors suggest that either cigarette smoking may increase inflammation or that other factors -- such as reduced physical activity in smokers -- may limit joint inflammation and damage.
Arthritis & Rheumatism 2001;44:323-330.
"The association of cigarette smoking with disease outcome in patients with early inflammatory polyarthritis"
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