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Does Smoking Affect Rheumatoid Arthritis

Effect Of Smoking On Drug Response In Ra

Smoking & Rheumatoid Arthritis

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.

Effect Of Smoking On Extra

Extra-articular manifestations of RA include various disease manifestations and the incidence of EAM is about 20%45% in RA . The recognition of EAM may be important, because it is associated with disease activity and greater mortality in RA . EAM include rheumatoid nodules, rheumatoid vasculitis, polyneuropathy, pleuritis, interstitial lung disease with fibrosis, pericarditis, haematological abnormalities, some types of ocular inflammation and secondary Sjögrens syndrome . There have been some reports on the relationship between smoking and EAM in RA .

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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Will I Be Able To Work How Do I Tell My Boss

I wont lie. Rheumatoid arthritis can lead to work disability, abseeteeism, and presenteeism at a high cost to you but also to your employer. Youve had the conversation with your family and friends but now its time to tell your boss.

First, youre not legally required to disclose your RA to your employer. However, as an employer myself, I would appreciate it if my employee would disclose this information. What if your job requires heavy lifting or standing around for a very long time? Maybe I can help you and re-arrange your work duties to better accommodate you? Maybe you need a better chair or a better mouse? Every situation is different. Not everyone with RA has horrible disease but on the flip side not everyones employer is accommodating.

Theres also the situation with doctors appointments. Most people with RA see their rheumatologist every 3 to 6 months for regular checkups. Some people may need medications that only come as infusions. These infusions are given in clinic and last between 1.5 hours to half a day. Thats more time off work.

By informing your employer, you are entitled to certain legal rights, as outlined in the Americans with Disabilities Act and the Family and Medical Leave Act. For more information, please click on the following link.

Ultimately, the choice to tell your boss or not is yours. You are in control.

Can Smoking Cause Rheumatoid Arthritis

Pin on RA

Yes and there is so much evidence!

Research studies show a strong link between smoking and autoimmune diseases such as rheumatoid arthritis and lupus. Autoimmune diseases are a group of disorders caused by the immune systems lack of self-control. The immune system is designed to attack foreign invaders to the body such as bacteria, viruses, fungi and parasites. In autoimmune disease, the immune system mistakes normal parts of the body as foreign and goes on the attack leading to hyperactivity and thus inflammation.

Rheumatoid arthritis is the classic example of an autoimmune disease. It is a chronic condition that predominantly affects your joints by causing pain, swelling and reduction in function with ultimate progression to irreversible damage. Although small joints in hands and feet are most commonly involved, rheumatoid arthritis can also affect larger joints as well other organs such as eyes, lungs, skin or kidneys.

Autoimmune diseases have a genetic component, making it more prevalent in certain families. These genetic predispositions lead to disease when a trigger is present. There are various proposed triggers including chemical exposure, stress and infections. Among these, chemical exposure related to tobacco use has been strongly linked to onset of multiple inflammatory autoimmune conditions including rheumatoid arthritis.

Dr. Francis has offices in Fishkill, New Windsor and Poughkeepsie # 614-0700

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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.

Clinical Practices For Smoking Cessation In Patients With Rheumatoid Arthritis

Smokers with RA may have different motivations for, and barriers to, quitting. There are physical limitations and disease-associated factors that may adversely affect smoking cessation in RA patients. Five key barriers to smoking cessation faced by RA patients have been identified in a previous study . First, patients were unaware of the relationship between smoking and RA and therefore did not perceive this as a reason to quit. Second, smoking was used as a distraction from pain. Third, patients found it difficult to exercise and therefore were unable to use exercise as an alternative distraction. Fourth, smoking was used as a coping mechanism for the frustrations of living with RA. Fifth, patients felt unsupported and isolated from other RA non-smoking patients. These barriers and targeted interventions for patients with RA are outlined in detail in Table 1. Moreover, becoming aware of the effects of smoking on arthritis may represent an important motivation to quit smoking and may counter RA-specific barriers to smoking cessation .


No potential conflict of interest relevant to this article was reported.

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Physical And Emotional Stress

While rheumatoid arthritis symptoms can often flare up for no apparent reason, certain things may trigger a sudden worsening of symptoms.

Physical overexertion is one of these things. While the mechanism for this is poorly understood, it’s believed that the sudden and excessive release of stress hormones, such as cortisol and adrenaline, may cause changes that indirectly intensify the autoimmune response. While this doesn’t in any way undermine the enormous benefits of exercise in treating rheumatoid, it does suggest that physical activity needs to be appropriate, particularly insofar as the joints are concerned.

The body’s response to physical stress may be mirrored by its response to emotional stress. While scientists have yet to find a clear association between stress and rheumatoid arthritis symptoms, people living with the disease often report that flare-ups come right after moments of extreme anxiety, depression, or fatigue.

Other common triggers include infections, including the cold or flu, which are associated with immune activation and eating certain foods that trigger an allergic response in some people, causing the immune system to react abnormally.

All of these factors place varying degrees of stress on the body which the immune system responds to, sometimes adversely.

Speak Up If You Want Help To Stop Smoking

Study: Smoking increases your risk, children’s risk for rheumatoid arthritis

Dont wait for your physician to ask you about your smoking habits before you commit to quitting. Even if your RA is well managed, it is still important to stop smoking cigarettes because of long-term cardiovascular disease risk. Quitting smoking helps control comorbidity diseases such as heart and lung disease, explains Bartels.

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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:

Cigarettes Cause More Severe Arthritis

March 15, 2002 — Here’s one more reason to quit smoking: it may save your joints. A new study shows cigarette smoking can cause a genetic reaction that leads to a more severe form of rheumatoid arthritis.

Rheumatoid arthritis is an often-debilitating condition in which the joints become painful, stiff, and swollen. Prior studies have shown that smokers seem to suffer from a more serious form of the disease, but it wasn’t clear why.

Researchers now say this study, published in the March issue of Arthritis and Rheumatism, suggests that smoking may trigger a genetic chain of events that leads to more severe RA.

The gene GSTM1 is involved with the processing of an enzyme that detoxifies the cancer-causing agents found in tobacco smoke. About 50% of Caucasians don’t have this gene. Prior studies have suggested that people lacking the GSTM1 gene have a more severe form of RA along with an increased risk of smoking-related cancers and heart disease.

Smoking has also been linked to an increase in the production of rheumatoid factor , the substance checked for in blood tests to help determine if someone has RA.

Based on those findings, researchers speculated that smoking in people who already lack this gene might play a role in the development of more severe RA. They examined a group of 164 women with RA, including smokers and nonsmokers.

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Smoking And Risk Of Ra Susceptibility

Previous epidemiological studies have identified smoking as an important risk factor for RA . Important studies are summarized in . Some studies demonstrate that smoking increases the risk of developing RA in men more than in women , while several other reports show that smoking increases the risk of developing RA in women . Recently, Sugiyama et al. conducted the first meta-analysis investigating the significance of smoking as a risk for developing RA, which suggested that smoking is indeed a risk factor for RA in RF-positive men and heavy smokers. The risk of developing RA was approximately twice as high for smokers than for non-smokers. For female smokers, the risk was approximately 1.3-times higher than for non-smokers . Even though many previous studies could not confirm a significant association between smoking and the development RA in women , Sugiyama et al. provided quantitative evidence that smoking is an important risk factor for women in developing RA .

Impacts Of Cigarette Smoking On Ra Pathogenesis

How Serious Is Rheumatoid Arthritis

4.1. Effects of Cigarette Smoking on Immune Systems

4.2. Interactive Effects of Cigarette Smoking and Genetic Components

4.2.1. Interactive Effects between CS and the HLA-DRB1 Gene on RA Development

4.2.2. Interactive Effects between CS and the HLA-DRB1 Gene on RA-Related Autoantibody Production

4.2.3. Interactive Effects between CS and the PTPN22 Gene on RA Pathology

4.2.4. Interactive Effects between CS and the PADI4 Gene on RA Pathology

4.3. Effects of CS on Epigenetic Changes

4.4. Cigarette Smoking Modulates Periodontal Disease Leading to a Higher Risk of RA Development

4.5. Airway Inflammation

4.6. The Role of Passive Smoking in RA Pathogenesis and the Role of Nicotine

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Drinking Too Much Alcohol

Drinking too much is not good for anyone’s health, Dr. Friedman says. That’s especially true for people who are on medications to reduce the joint pain and swelling of rheumatoid arthritis and to slow its progression. The problem is that alcohol taxes your liver, and so can RA medications, including methotrexate, “so heavy drinking can be a double whammy,” Friedman says.

Drinking also can reduce your bone density, and a lower bone density puts you at greater risk for complications from arthritis, including fractures. Love your merlot? Drink in moderation, and ask your doctor if the general health rule of one drink a day for women, two for men, is the right one to follow.

Cigarette Smoking As The Most Robust Environmental Risk Of Ra

3.1. Effects of Intensity and Duration of Cigarette Smoking and Smoking Cessation

3.2. Effects of Passive Smoking

3.3. Effects of Cigarette Smoking on RA-Related Autoantibody Production

3.4. Other Environmetal Risks Augmented by Cigarette Smoking

3.4.1. Occupational Silica Exposure

3.4.2. Alcohol Consumption

3.4.3. Sugar-Sweetened Soda Consumption

3.4.4. High Salt Intake

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Complications Of Smoking With Ra

Extra-articular manifestations of RAthat is symptoms and conditions not directly related to the musculoskeletal systemare often reported in people with RA who smoke.

EAMs are a result of higher disease activity in RA and may include rheumatoid nodules, rheumatoid vasculitis, pleuritis, interstitial lung disease, pericarditis , eye inflammation, and secondary Sjogrens syndrome.

In a study reported in 2012 in the Brazilian journal RevistaBrasileiradeReumatologia, Brazilian researchers reviewed the medical charts of 262 people with RA. During the course of the disease, 120 of the people with RA developed EAMs of RA, specifically pulmonary disease, rheumatoid nodules, and Sjogrens syndrome.

The 120 participants with EAMs tested positive for RF and had high levels of anti-CCPs in their bloodwork. The researchers confirmed that smoking was linked to the presence of EAMs and the current smokers had the highest risk for the development of EAMs.

How Cannabis Works On Rheumatoid Arthritis

Rheumatoid Arthritis

Medical cannabis comes from the plant cannabis sativa and affects the body by interacting with the endocannabinoid system . The ECS system is broadly made up of cannabinoid molecules that activate the system, receptors that are distributed all over the body and are activated by the cannabinoid molecules and enzymes that play an important role in the synthesis and degradation of the cannabinoids.

The ECS can be activated by cannabinoids that are naturally produced in the body endocannabinoids or those produced externally and consumed. These external cannabinoids include plant-based cannabinoids from cannabis sativa known as phytocannabinoids or cannabinoids that are synthesized in a pharmaceutical setting for example Nabilone. Much of our understanding of the ECS on the body has come from studying the effects of endocannabinoids, phytocannabinoids and synthetic cannabinoids. The most-studied phytocannabinoids are tetrahydrocannabinol and cannabidiol , which are thought to cause the main effects of cannabis. Nonetheless, there are at least 140 phytocannabinoids identified in cannabis sativa and though these other cannabinoids are not as well studied as THC and CBD they are also likely to also have some effect on the body.

ECS receptors & RA

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Smoking Can Make Ra Worse

Smokers with RA have a more active disease process than those who never smoked or have stopped smoking. High disease activity in RA often equals swollen or tender joints, signs of high inflammation in your blood, or more joint pain.

Active disease in RA leads to joints that donât work as well. They can become stiff, bent, or damaged. You may even need surgery to repair or replace them down the road.

The Effect Of Alcohol On The Immune System

In line with innate immunity, NK cells are increased in the synovial fluids of RA patients, contributing to disease by pro-inflammatory cytokine secretion and bone destruction . Alcohol also affects NK cells one study concluded that the deficiencies in NK cell function observed in chronic alcohol drinkers could be due to cell loss with a reduction in CD56+ CD45RA+ NK cells by > 60% rather than direct effect of alcohol on NK cells . However, this interpretation should be taken carefully, as the study was performed in the scope of alcoholic liver disease during an episode of alcoholic hepatitis. Meanwhile, invariant natural killer T cells in alcohol-consuming mice demonstrated increased cell maturation and higher IL-12 and IFN- production, ultimately favoring Th1 immune response . The mucosa-associated invariant T cell population of the gut have also been shown to be reduced, along with decreased expression of IFN- and TNF- upon alcohol-induced dysbiosis . Alcohol also affects granulopoiesis by preventing stem cell antigen 1 directed proliferation during bacteremia .

In summary, both innate and adaptive immune cells have been reported to be affected upon alcohol exposure. Decreased MHC-I, MHC-II, proinflammatory cytokines, co-stimulatory molecule expression, localization, and migration cause an overall suppression of immune system surveillance, antigen-presentation, and T cell activation.

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Elevation Of Serum Fibrinogen

Fibrinogen is mainly involved in blood coagulation and inflammation. The Framingham Study has revealed that smokers have higher levels of serum fibrinogen . The citrullinated form of fibrin can be found in RA synovial tissue co-localizing with citrullinated autoantibodies . It has been reported that the polymerization of citrullinated fibrinogen catalyzed by thrombin is impaired, suggesting that the function and antigenicity of citrullinated proteins are somewhat altered, which may potentially contribute to proinflammatory responses and autoimmune reactions in the joints .

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