Smoking and Arthritis: a Joint Problem


Smoking is a risk factor for many diseases including heart attacks, strokes, and cancer.  It also increases the risk of developing inflammatory joint conditions including rheumatoid arthritis and psoriatic arthritis.  Smoking leads to more active disease, more joint damage, and more adverse effects elsewhere in the body.  It is linked with active skin disease in SLE and can lead to poorer outcomes in several conditions including ankylosing spondylitis and systemic sclerosis.  Smoking can also reduce response to treatment, and patients who smoke often require higher doses of immunosuppressive treatment to control their symptoms.


Smoking increases the risk of developing rheumatological disease:

Risk of developing seropositive rheumatoid arthritis is doubled on average in patients who smoke.  The risk relates to the number of cigarettes you smoke per day and the number of years you have smoked for, with those who smoke heavily (>20 cigarettes per day) at much higher risk of developing rheumatoid arthritis.  If you are a smoker and have a family member with rheumatoid arthritis your risk is higher again (up to 50x higher than the general population).


Smoking makes symptoms and prognosis worse:

Once a diagnosis of inflammatory arthritis has been reached patients who continue to smoke have higher levels of inflammatory cells in their body which is associated with more active and aggressive disease.  This causes more symptoms of joint pain and swelling and can lead to poorer outcomes including joint damage, deformity, and loss of function.  Smoking also increases the risk of adverse effects elsewhere in the body such as rheumatoid nodules, inflammation of the blood vessels (vasculitis), or rheumatoid lung disease.  Patients with rheumatoid arthritis are also more susceptible to developing cardiovascular disease than the general population and smoking further increases this risk.  Continuing to smoke following diagnosis of rheumatoid arthritis therefore significantly increases future risk of heart attacks, strokes, and premature death.


Smoking reduces the effectiveness of treatment:

Smokers often fail to respond to oral or injectable medications and require higher doses or a combination of a number of different medications to control their symptoms.  Sometimes this is not enough and more highly immunosuppressive biologic therapies are required.  30% of smokers require biologic therapy to control their symptoms compared with 10-15% of non-smokers.  However, smokers are also at higher risk of infections such as chest infections and therefore the more the immune system is suppressed by medication, the more likely a smoker is to get an infection.


Patients who decide to stop smoking may find that they are able to reduce or stop immunosuppressive medication without experiencing a flare.


What about passive smoking and vaping?

Passive smoking in childhood has been shown to increase future risk of developing rheumatoid arthritis, particularly if there is a family history of rheumatoid arthritis.


Vapes contain less chemicals than cigarette smoke and may reduce risk of developing autoimmune disease.  However rate of heart attacks and strokes are still high in patients who vape.  Therefore, although vaping can be an effective stepping stone to helping patients quit the best solution long term is to stop smoking completely.


So how can I get help to quit?


The best way to quit is by using Champix or NRT with support from QUIT YOUR WAY SCOTLAND.

For further information call SMOKELINE 0800 84 84 84, contact your community pharmacist, or speak to one of the members of the rheumatology team at your next appointment.