PALO ALTO, CA—Cigarette smoking is a major risk factor for rheumatoid arthritis and has been associated with increased disease severity and lower rates of disease remission.

A recent study published in the journal Rheumatology found that to be the case with current smokers at the VA and recommended stepped-up tobacco cessation programs for those veterans.1

VA Palo Alto Health Care System-led researchers hypothesized that inflammation and disease activity would be associated with smoking status and this would be related to levels of anti-citrullinated protein antibodies (ACPA).

For the study, researchers focused on 1,466 patients in the VA’s RA registry—76.9% anti-CCP2 positive, 89% male, median age 63 years, median disease duration 8.45 years.

Baseline serum samples were evaluated for levels of anti-CCP2, rheumatoid factor (RF), 19 distinct ACPAs and 17 cytokines. In addition, smoking status was determined and recorded as current, former or never.

Results indicate that, among anti-CCP-positive RA patients, RA-associated cytokines and the disease activity score 28 (DAS28) were higher in current smokers compared with former or never smokers, while they were similar among former and never smokers. On the other hand, ACPA concentrations were higher among both current and former smokers compared with never smokers, and levels of ACPA were not associated with DAS28 or cytokine levels.

“Among anti-CCP2-positive RA patients, current smoking status is associated with elevations in pro-inflammatory cytokines and increased RA disease activity,” the study authors concluded. “Similar levels of inflammation and disease activity among former and never smokers suggests that the detrimental effects of smoking could be ameliorated through tobacco cessation. The effect of tobacco cessation on RA disease activity should be evaluated prospectively. “

1 Sokolove J, Wagner CA, Lahey LJ, Sayles H, et. al. Increased inflammation and disease activity among current cigarette smokers with rheumatoid arthritis: across-sectional analysis of US veterans. Rheumatology (Oxford). 2016 Jul 31. pii:kew285. [Epub ahead of print] PubMed PMID: 27477806.