Smoking at onset of rheumatoid arthritis (RA) and its effect on disease activity and functional status: experiences from BARFOT, a long-term observational study on early RA

• Published in: Scandinavian journal of rheumatology 2011-01, Vol.40 (4), p.249-255
• Main Authors: Söderlin, MK, Petersson, IF, Bergman, S, Svensson, B
• Format: Article
• Language: English
• Subjects: Adult; Aged; Antibodies - blood; Arthritis, Rheumatoid - blood; Arthritis, Rheumatoid - diagnosis; Arthritis, Rheumatoid - physiopathology; Biological and medical sciences; C-Reactive Protein - metabolism; Clinical Medicine; Cohort Studies; Diseases of the osteoarticular system; Female; Follow-Up Studies; Health Surveys; Humans; Inflammatory joint diseases; Klinisk medicin; Longitudinal Studies; Male; Medical and Health Sciences; Medical sciences; Medicin och hälsovetenskap; Middle Aged; Pain Measurement; Peptides, Cyclic - immunology; Prognosis; Retrospective Studies; Reumatologi och inflammation; Rheumatoid Factor - blood; Rheumatology and Autoimmunity; Severity of Illness Index; Smoking - adverse effects; Sweden; Tobacco, tobacco smoking; Toxicology
• ISSN: 0300-9742; 1502-7732; 1502-7732
• DOI: 10.3109/03009742.2010.541495

Objectives: To assess the effects of smoking on disease outcome in a large cohort of patients with early rheumatoid arthritis (RA). Methods: Between 1996 and 2004, 1787 adult patients (disease duration ≤ 1 year) were included in the BARFOT early RA study in Sweden. Smoking status was recorded at inclusion in the study. Disease Activity Score using 28 joint counts (DAS28), C-reactive protein (CRP), Health Assessment Questionnaire (HAQ) score, rheumatoid factor (RF), antibodies to cyclic citrullinated peptide (anti-CCP), general health (GH) and pain visual analogue scales (VAS), and drug treatment were registered at inclusion and at follow-up at 3, 6, and 12 months. European League Against Rheumatism (EULAR) response and remission criteria were applied at 3, 6, and 12 months. Results: The proportion of patients who smoked at inclusion in the study fell from 29% in 1996 to 20% in 2004. There were no significant differences in disease activity at inclusion stratified according to smoking status. At 12 months of follow-up, 18% of current smokers at inclusion, 12% of previous smokers, and 11% of never smokers had high disease activity (DAS28 > 5.1, p = 0.005). Significantly fewer current smokers were in remission at 12 months (33%) compared to never smokers (36%) and previous smokers (42%) (p = 0.013). Current smoking at inclusion independently predicted poor EULAR response up to 12 months of follow-up. Conclusion: The present study gives some support to earlier data indicating that RA patients who smoke have a more active disease but further studies are needed to confirm this.