Tossing your cigarettes may help control your rheumatoid arthritis, according to research presented this week at the American College of Rheumatology Annual Scientific Meeting in San Francisco, Calif.

Rheumatoid arthritis is a chronic disease that causes pain, stiffness, swelling, and limitation in the motion and function of multiple joints. Though joints are the principal body parts affected by RA, inflammation can develop in other organs as well. An estimated 1.3 million Americans have RA, and the disease typically affects women twice as often as men.

Smoking is known to increase the risk and severity of RA. Smoking cessation has been shown to have a positive impact in slowing the progression of other diseases such as coronary disease and emphysema.

Researchers recently evaluated 14,847 patients with RA based on their smoking status. Of those, 65.4 percent were non-smokers, 22.1 percent were former smokers, and 12.5 percent were active smokers. Smoking cessation was defined as patient-reported cessation over two consecutive physician office visits, and independent variables in the study included patient age, gender, ethnicity, rheumatoid factor status, and use of different therapies for treating RA.

Researchers primarily monitored change in Clinical Disease Activity Index—a composite measure of disease activity in people with RA that assesses change over time— as well as other measures of disease activity including tender and swollen joint counts and laboratory tests.

Among 1,405 patients who smoked at enrollment into the registry, 21.1 percent successfully stopped smoking. In comparing this group to patients who continued to smoked, researchers found no significant differences in disease duration, rheumatoid factor or CCP status, non-biologic DMARD or biologic use. However, at the last follow-up visit, Clinical Disease Activity Index was higher among active smokers than among patients who had stopped smoking. Individual measures of active disease including swollen and tender joint counts and C-reactive protein were all lower in the patients who had stopped smoking.

These results suggest that stopping smoking can lessen RA disease activity over and above current medical treatment.

“While these results are preliminary, it seems that quitting smoking, which would have many other health benefits, also may benefit patients with rheumatoid arthritis,” explains Mark C. Fisher, MD, MPH; Research Fellow, NYU Medical Center; Hospital for Joint Disease, New York, N.Y. “RA patients who stop smoking may see an improvement in the number of joints that hurt them every day and in how they feel overall,” he says, noting that further research is necessary to confirm these early findings.

The ACR is an organization of and for physicians, health professionals, and scientists that advances rheumatology through programs of education, research, advocacy and practice support that foster excellence in the care of people with or at risk for arthritis and rheumatic and musculoskeletal diseases. For more information on the ACR’s annual meeting, see http://www.rheumatology.org/annual.

Editor’s Notes: Dr. Fisher will present this research during the ACR Annual Scientific Meeting at the Moscone Center from 11:00 AM – 12:30 PM on Monday, October 27, in Hall C. Dr. Fisher will be available for media questions and briefing at 8:30 AM on Tuesday, October 28 in the on-site press conference room, 114.

Presentation Number: 1188

Smoking Cessation and Improvement of RA Disease Activity

Mark C. Fisher1, Muhammad El-Taha2, Joel M. Kremer3, Cheng Peng2, Jeffrey Greenberg1. 1NYU - Hospital for Joint Diseases, New York, NY; 2University of Southern Maine, Portland, ME; 3Albany Center for Rheumatology, Albany, NY

Purpose: The relationship between smoking and both the development of Rheumatoid Arthritis (RA) as well as disease severity has been established. In other diseases, such as coronary disease and emphysema, smoking cessation has been shown to have a positive impact on disease progression. To date, the impact of smoking cessation on RA disease activity has not been explored.

Methods: All patients in the CORRONA registry with a diagnosis of RA were evaluated for their smoking status at time of enrollment. Smoking cessation was defined as patient-reported cessation of smoking over two consecutive visits. The primary outcome was change in Clinical Disease Activity Index (CDAI) as a continuous variable. Secondary outcomes were tender (T) and swollen (S) joint counts (JC) and mHAQ. Additional outcomes were DAS-28, ESR and CRP, but were limited by lab result availability. Independent variables included were patient age, gender, ethnicity, RF status, non-biologic DMARD use, biologic use and prednisone dose, which were analyzed for both direct comparison and multivariate regression analysis.

Results: As of 10/07, there were 14,847 patients enrolled in CORRONA with a diagnosis of RA who reported smoking status. Of those, 9,709 (65.4%) were non-smokers, 3,287 (22.1%) were former smokers, and 1,851 (12.5%) were active smokers. Among 1,405 patients who smoked at enrollment into the registry with at least 3 visits, 297 (21.1%) successfully ceased smoking. Comparing the active smoker versus ceased smoker cohorts, there were no significant differences in disease duration, RF or CCP status, nonbiologic DMARD or biologic use. At last follow-up visit, CDAI was higher among active smokers (13.4, SD 12.5) than among ceased-smokers (10.5, SD 10.5), which was statistically significant (p < 0.0001). Similarly, SJC (p<0.01), TJC (p<0.01), and CRP (p<0.01) were all lower in patients who stopped smoking. A similar trend was noted for mHAQ (p=0.06), but not ESR. Among patients with lab values (39% of the cohort), a similar effect on DAS-28 was observed (3.25 vs 3.47) but did not reach statistical significance (p=0.13). After controlling for other potential confounders in a regression model, continuation of smoking (vs smoking cessation) was associated with an increase in CDAI score (coefficient 0.42, CI 0.15 - 0.69, p = 0.003).

Conclusions: To our knowledge, this is the first study demonstrating a reduction in disease activity measures among RA patients who stop smoking. Smoking cessation as an intervention to control RA disease activity is supported by these data and requires further study.

Disclosure Block: M.C. Fisher, None; M. El-Taha, None; J.M. Kremer, Abbot, 2; Amgen, 2; BMS, 2; Centocor, 2; Genentech, 2; Roche, 2; Abbot, 5; Amgen, 5; BMS, 5; Centocor, 5; Genentech, 5; Roche, 5; Merck, 5; Pfizer, 5; CORRONA, 6; C. Peng, None; J. Greenberg, BMS, 2; Roche, 5; Novartis, 5; UCB, 5; BMS, 5; CORRONA - Chief Scientific Officer, 6.

Source: American College of Rheumatology (ACR)