How Was This Study Done
Patients were referred to the Johns Hopkins Arthritis Center for inflammatory arthritis after ICI therapy and followed over time . Symptoms and signs of arthritis as well as the use of medications for inflammatory arthritis were evaluated at each follow-up visit in rheumatology. Additionally, information on cancer status was obtained at each visit. The percentage of patients with persistent arthritis was calculated at 3 months and 6 months after immunotherapy cessation. Statistical models were used to determine factors that influenced whether patients had persistent arthritis.
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Reasons Smoking Makes Arthritis Worse
If the risks of lung disease, heart disease, cancer and bad breath werent good enough reasons for you to give up smoking, heres something else you should know: Research shows that smoking is harmful to your bones, joints and connective tissue as well. No matter what form of arthritis you have, youll be doing your joints and yourself a favor by quitting. Here are five more reasons for people with arthritis to snuff the habit.
Higher death risk. A 2016 study published in Arthritis Care & Research analyzed data from 5,677 patients with rheumatoid arthritis and found that, over an average follow-up period of almost five years, death rates for smokers were almost double that of nonsmokers. Cardiovascular disease was the major cause of death. The good news: mortality risk fell significantly a year after quitting, particularly for heavy smokers, and it continued to fall each subsequent year.
More surgery complications. Two separate studies, presented at the 2012 annual meeting of the American Academy of Orthopaedic Surgeons, compared joint replacement in smokers and nonsmokers.
One, which followed 621 patients with an average age of 62, found those who smoked before and after total knee replacement had a 10-fold higher revision rate compared to nonsmokers. The other found that smokers who had the cup part of the hip joint replaced with a metal prosthesis had almost three times the implant failure rate compared to nonsmokers.
Theres A Link Between Smoking And Ra
Lighting up makes you more likely to get RA even if you havenât been a heavy smoker. The more you smoke, the higher your chances go. Cigarettes can make your RA more severe.
Smoking boosts inflammation, and RA involves inflammation thatâs out of control because your immune system attacks your own healthy tissues by mistake. Your synovium, the tissue that lines your joints, can get inflamed and thickened. Tobacco smoke includes lots of nasty substances like free radicals. They put stress on your body and can trigger inflammation.
Smokers have higher levels of inflammatory proteins called cytokines in their body. These play a role in the joint and organ damage that comes with RA. Tobacco smoke causes your body to release all kinds of cytokines linked to inflammation in RA.
Smoking may also cause your body to make anti-CCP antibodies. These can lead to more severe RA in people with a gene called HLA-DRB1.
Smoking And Rheumatoid Arthritis: A Case For Smoking Cessation
Although there is strong evidence linking cigarette smoke exposure with RA, the specific effect of smoking on radiographic progression of disease is less clear. There is some evidence that smoking may be a risk factor for radiographic progression in early RA.14,15 It is unknown, however, the extent to which smoking cessation can halt progression or reverse pathologic changes associated with RA.
Data from the Consortium of Rheumatology Researchers of North America and from the Better AntiRheumatic PharmacOTherapy project in early RA in Sweden showed that smoking cessation after the onset of RA did not change the prognosis for smokers with RA.16,17 In fact, it has been reported that the risk for RA may persist for several years after smoking cessation, even among moderate smokers.18
The discovery that cigarette smoke condensate can induce the production of proinflammatory cytokines in synovial fibroblasts has led to growing interest in how smoking affects response to RA treatment, particularly to biologic agents. The available research is conflicting. A study by Maska and colleagues reported that, among patients with early RA and poor prognostic factors, smoking status had no impact on treatment response to early combination therapy or initial methotrexate with step-up therapy or to triple therapy .19
How Stopping Smoking Can Help Your Rheumatoid Arthritis
There are many compelling reasons to stop smoking with which you are most likely familiar, including lower risks of various cancers, strokes, and heart disease and less financial strain because you would no longer depend on expensive cigarettes to get you through the day. On top of those reasons, we at the Arthritis, Rheumatic, & Bone Disease Associates can add another reason, backed by medical research, for our patients to stop smoking: smoking can make your day-to-day struggle with rheumatoid arthritis even worse.
Below we have compiled a few points about how smoking can affect your RA and the benefits for your RA and your overall health which are associated with smoking cessation.
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How Your Treatment Changes As Ra Progresses
Early stage. A key focus is to control the inflammation. Thatâs especially critical in the early phase of the disease to prevent joint damage. You may get:
- A disease-modifying antirheumatic drug , such as methotrexate
- Nonsteroidal anti-inflammatory drugs , such as aspirin and ibuprofen, for pain
Moderate stage. This is when you may have trouble with regular daily activities because of pain. You also may tire more easily. There are several options. Your doctor may have you try combining methotrexate with two other DMARD medications, sulfasalazine and hydroxychloroquine. Another option is a stronger form of DMARDs, called biologic DMARDs, including:
Who Is At Risk For Psoriatic Arthritis
Psoriasis affects 2-3 percent of the population or approximately 7 million people in the U.S. and up to 30% of these people can develop psoriatic arthritis. Psoriatic arthritis occurs most commonly in adults between the ages of 35 and 55 however, it can develop at any age. Psoriatic arthritis affects men and women equally.
It is possible to develop psoriatic arthritis with only a family history of psoriasis and while less common, psoriatic arthritis can occur before psoriasis appears. Children of parents with psoriasis are three times more likely to have psoriasis and are at greater risk for developing psoriatic arthritis. The most typical age of juvenile onset is 9-11 years of age.
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Smoking Worsens Ra Disease Severity And Works Against Treatments
Cigarette smoking may even make some rheumatoid arthritis symptoms worse. Patients who continue to smoke have more damage over time and are more likely to have treatment failures. Also, rheumatoid arthritis is a cardiovascular disease risk factor, and adding smoking to that creates a compounded risk, cautions Christie M. Bartels, MD, an assistant professor in the division of rheumatology at the University of Wisconsin School of Medicine and Public Health in Madison.
Rheumatologists Dont Always Ask About Quitting
Dr. Bartels was part of a research team that recently discovered that rheumatologists are less likely to counsel people about quitting smoking if their RA is controlled. Many of the rheumatologists were not aware that a third of smokers are ready to try to quit or cut back if asked. We need more training for rheumatologists. We also need to train the nurses and medical assistants to help patients and teams know the quit resources, says Bartels. The research findings were published in the August 2017 issue of JCR: Journal of Clinical Rheumatology.
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Having A Cold Or Other Infection
Getting sick can start a chain reaction that leads to painful arthritis symptoms. According to Dr. Jain, infections can make your immune system even more active, making it likelier it will attack your own joints. We also often tell patients to stop taking their rheumatoid arthritis medication if they are on antibiotics , says Dr. Jain. That combination can lead to flares. It can be harder for rheumatoid arthritis patients to avoid getting sick since the medication prescribed often suppresses the immune system. Thats why its so important to reduce your risk, like by getting the flu vaccine every year, washing your hands frequently, and avoiding others who are ill.
No matter what triggered your flare, its important to talk to your doctor and get it under control as soon as you can to avoid serious damage to your joints.
How Is Ra Treated
RA can be effectively treated and managed with medication and self-management strategies. Treatment for RA usually includes the use of medications that slow disease and prevent joint deformity, called disease-modifying antirheumatic drugs biological response modifiers are medications that are an effective second-line treatment. In addition to medications, people can manage their RA with self-management strategies proven to reduce pain and disability, allowing them to pursue the activities important to them. People with RA can relieve pain and improve joint function by learning to use five simple and effective arthritis management strategies.
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Who Develops Rheumatoid Nodules
Most commonly, rheumatoid nodules develop in patients already living with rheumatoid arthritis for some time. They generally dont precede other rheumatoid arthritis symptoms.
Research suggests that rheumatoid nodules are commonly found in patients who possess high levels of the protein rheumatoid factor, an antibody seen in a handful of autoimmune disorders. This may mean that the patients may require treatment with drugs in the class of immunomodulators, such as Methotrexate.
Similarly, research has also shown an increased likelihood of developing nodules in rheumatoid arthritis patients who smoke, even though a direct link between smoking and the formation of rheumatoid nodules is still unclear.
Can You Drink If You Have Ra
If you enjoy beer, wine, or a mixed drink now and then, it may be good for you even if you have RA. The catch: You need to limit how much you drink.
You could lower your risk of heart disease or even death if youâre a light to moderate drinker, even more than if you donât drink at all. Thatâs true even if you take methotrexate, a common RA treatment.
Whatâs moderate drinking? Itâs only about one small drink per day for women and two drinks per day for men. Thatâs about 14 grams of alcohol per drink, since every type of drink has other ingredients too, such as water or sugar.
Drink sizes really vary, but standard servings of alcohol are:
- 12 ounces of beer
- 8 ounces of malt liquor
- 5 ounces of wine
- 1.5 ounces of liquor or whiskey
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Childhood Exposure To Parental Smoking Increases Risk Of Rheumatoid Arthritis In Adulthood
Active cigarette smoking is the best-established modifiable risk factor for the development of rheumatoid arthritis , but whether passive smoking can be linked to RA is unclear.
Kazuki Yoshida, MD, ScD, instructor in Medicine, and Jeffrey A. Sparks, MD, MMSc, assistant professor of Medicine, both of the Department of Medicine and Division of Rheumatology, Inflammation and Immunity at Brigham and Womens Hospital, and colleagues recently conducted a study to examine the influence of passive smoking in a large prospective cohort at several stages of the life course, including in utero, while accounting for pack-years of active smoking.
In Arthritis & Rheumatology, they report an increased risk of seropositive RA associated with exposure to childhood parental smoking, especially when combined with active smoking in adulthood.
Smoking And Obesity Add To The Burden Of Inflammation
Rheumatoid arthritis is caused by your immune system attacking parts of your own body as if they were dangerous germs. Among other tissues, the immune system targets membranes surrounding your joints, which are called the synovium. That leads to inflammation that can damage and even destroy the joints’ bone and cartilage.
As in other autoimmune disorders, such as lupus and psoriasis, the underlying cause of rheumatoid arthritis is not well understood. What doctors do know is that certain factorsincluding smoking and obesitycan place you at higher risk of not only getting the disease, but having more severe symptoms.
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Types Of Pain Smokers Feel
In the Annals of the Rheumatic Diseases study referenced above, the most pronounced type of pain that smokers felt was back pain.3 However, this wasnt the only type of pain reported from the surveys. Neck, shoulder, hip, knee, hand, and elbow pain were also more common in smokers than non-smokers.
Also, individuals who already have joint conditions like osteoarthritis experience more severe pain and loss of bone cartilage if they are smokers. Another study involving 159 men with symptomatic knee osteoarthritis found that on a pain scale of one to 100, smokers reported an average pain score of 60 and non-smokers just 45.8 To explain this increase in knee pain, the researchers hypothesized that smoking may increase oxidant stress to destroy cartilage, inhibit cell proliferation, and increase carbon monoxide in the blood to prevent cartilage repair.
Your Expectations May Also Play A Role
It may seem that a persons response to a medication that might lead to remission is a purely physical thing, but theres evidence to the contrary.
When 100 people with RA were asked questions before they started a new DMARD and then evaluated later for physical improvements, more than 10 percent of their treatment response could be attributed to their earlier expectation that the drug would be effective, according to a study published in Therapeutic Advances in Musculoskeletal Disease in May 2021.
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Smoking And Cardiovascular Disease
Smokers are at greater risk for diseases that affect the heart and blood vessels .1,2
- Smoking causes stroke and coronary heart disease, which are among the leading causes of death in the United States.1,3
- Even people who smoke fewer than five cigarettes a day can have early signs of cardiovascular disease.1
- Smoking damages blood vessels and can make them thicken and grow narrower. This makes your heart beat faster and your blood pressure go up. Clots can also form.1,2
- A stroke occurs when:
A New Study Examined The Relationship Between Childhood Smoking Exposure And The Development Of Rheumatoid Arthritis Later In Life
Although doctors dont know the exact cause of rheumatoid arthritis , they do know certain risk factors such as genetics and family history can increase your chances of developing the disease. Smoking is also a known risk factor for developing RA and the risk isnt limited to active smokers
According to a new study, being exposed to smoking as a child can increase your chances of developing RA later in life.
For the study, which was published in the journal Arthritis & Rheumatology, researchers used data available from the Nurses Health Study II to examine the relationship between exposure to passive smoking and the development of RA. The data included information from 90,923 women, which was collected every two years from 1989 to 2017 via a questionnaire.
Researchers used medical records to determine which patients had a confirmed rheumatoid arthritis diagnosis. They also assessed whether patients had seronegative or seropositive RA, meaning their blood has antibodies that can attack the body and inflame the joints. Of the 90,923 participants, 532 had confirmed RA cases .
Using a questionnaire, researchers gained insight into the smoking exposure of patients. There were three passive smoking exposures of interest:
- Maternal smoking during pregnancy
- Parental smoking during childhood
- Adult passive smoking
Researchers did not find a link between RA development and in utero exposure or adult exposure to smoking.
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What Are The Complications Of Ra
Rheumatoid arthritis has many physical and social consequences and can lower quality of life. It can cause pain, disability, and premature death.
- Premature heart disease. People with RA are also at a higher risk for developing other chronic diseases such as heart disease and diabetes. To prevent people with RA from developing heart disease, treatment of RA also focuses on reducing heart disease risk factors. For example, doctors will advise patients with RA to stop smoking and lose weight.
- Obesity. People with RA who are obese have an increased risk of developing heart disease risk factors such as high blood pressure and high cholesterol. Being obese also increases risk of developing chronic conditions such as heart disease and diabetes. Finally, people with RA who are obese experience fewer benefits from their medical treatment compared with those with RA who are not obese.
- Employment. RA can make work difficult. Adults with RA are less likely to be employed than those who do not have RA. As the disease gets worse, many people with RA find they cannot do as much as they used to. Work loss among people with RA is highest among people whose jobs are physically demanding. Work loss is lower among those in jobs with few physical demands, or in jobs where they have influence over the job pace and activities.
Effect Of Smoking On Drug Response In Ra
Recent studies have shown an influence of cigarette smoking on RA patients response to anti-rheumatic drugs . A study by Hyrich et al. from the British Society for Rheumatology Biologics Register found that RA patients who smoke show a reduced clinical response to infliximab, an anti TNF- drug 0.77 ) . Following that study, Mattey et al. also demonstrated that poor response to the drug is linked to the pack-year history of smoking, as well as the smoking status of patients at the initiation of anti TNF- drug treatment, especially infliximab . More recently, Abhishek et al. found in their multivariate analysis that smokers taking an anti TNF- drug have a reduced chance of achieving a moderate response on the European League Against Rheumatism response criteria compared to non-smokers. 0.20 , p = 0.03) . However, there have been no studies on the effect of smoking on the response to tocilizumab or rituximab.
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