Skip to main content

Main menu

  • Home
  • Our journals
    • Clinical Medicine
    • Future Healthcare Journal
  • Subject collections
  • About the RCP
  • Contact us

Clinical Medicine Journal

  • ClinMed Home
  • Content
    • Current
    • Ahead of print
    • Archive
  • Author guidance
    • Instructions for authors
    • Submit online
  • About ClinMed
    • Scope
    • Editorial board
    • Policies
    • Information for reviewers
    • Advertising

User menu

  • Log in

Search

  • Advanced search
RCP Journals
Home
  • Log in
  • Home
  • Our journals
    • Clinical Medicine
    • Future Healthcare Journal
  • Subject collections
  • About the RCP
  • Contact us
Advanced

Clinical Medicine Journal

clinmedicine Logo
  • ClinMed Home
  • Content
    • Current
    • Ahead of print
    • Archive
  • Author guidance
    • Instructions for authors
    • Submit online
  • About ClinMed
    • Scope
    • Editorial board
    • Policies
    • Information for reviewers
    • Advertising

Smoking: keeping the joint alight

Maria Mouyis and Sonya Abraham
Download PDF
DOI: https://doi.org/10.7861/clinmedicine.12-4-399
Clin Med August 2012
Maria Mouyis
Charing Cross Hospital, Imperial College Healthcare Trust
Roles: Specialist registrar in rheumatology and general medicine
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Sonya Abraham
Charing Cross Hospital, Imperial College Healthcare Trust
Roles: Senior lecturer and honorary consultant in rheumatology and general medicine
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Info & Metrics
Loading

The topic of smoking seems to be quite controversial of late, with the health hazards being advertised across the board, from smoking cartons to billboards. Despite the increased publicity and warnings, people at large continue to smoke. This is of significant concern considering the health risks of smoking. Smokers reduce their life expectancy by ten years compared to non-smokers, with death being attributable to cardiac, vascular, pulmonary and cancer-related conditions.

Smoking is a recognised risk factor in atherosclerosis, cardiovascular disease, chronic obstructive pulmonary disease (COPD), lung cancer and rheumatoid arthritis (RA). Rheumatoid arthritis alone can contribute to cardiovascular disease. Patients with RA have a two-fold risk of developing a myocardial infarct or a stroke.1 Therefore, the combination of smoking and RA significantly increases cardiovascular risk.

A recent spot audit to assess the efficacy of the clinician providing smoking cessation advice was performed in our rheumatology clinic. The results proved dismal and potentially reflect current medical practice across London. Twenty-five sets of patient notes of RA patients and 25 sets of patient notes of psoriatic arthritis patients were audited. The objective was to assess whether the patients were active smokers and whether smoking cessation advice had been encouraged and documented. Cessation advice was given in 0% of cases. However, this may be an inaccurate figure, reflecting flaws in the documentation of verbal advice given to patients in the pressured outpatient setting. In reality, one would hope that doctors and health clinicians encourage smoking cessation more frequently in this environment.

The audit was performed to highlight the importance of smoking cessation in patients with inflammatory types of arthritis, especially RA. In keeping with National Rheumatoid Arthritis Society (NRAS) educational material, smoking increases the risk of developing RA by 50%, as well as decreasing the efficacy of treatment, leading to more severe RA in smokers rather than non-smokers.2

Although the pathogenesis is unclear, the pro-inflammatory effect of cigarette smoke on tissue joints is one contributing factor. Smoking upregulates cyclooxygenase (COX)-2 in the oral mucosa in response to increased epidermal growth factor signalling. The upregulation of COX-2 receptors may also occur in the joints.3 Smoking also induces the expression of rheumatoid factor, even in patients without RA.4 A nationwide study from Denmark highlighted that patients who smoke heavily and are homozygous for the shared epitope have an increased risk of anti-CCP antibody positive RA.5 The strongest association is noted between PTPN22, smoking and anti-CEP-1.6

The benefits gained from treating RA are reduced by the effect of smoking. Saevarsdottir et al demonstrated that at three months smokers had a lower response rate to treatment than non-smokers.7 Further studies showed that active smoking could be used as a predictor of poor response to treatment, even at 12 months.8

Smoking not only contributes to the susceptibility of RA and accelerates cardiovascular risk, it also decreases the efficacy of treatments. Education is paramount, as 60% of smokers do not perceive increased health risks secondary to smoking.9 We would urge clinicians to encourage their patients to stop smoking and provide them with smoking cessation advice in verbal and written form. There can be no doubt about the benefit of stopping smoking and we should be actively promoting smoking cessation in our rheumatology clinics and outpatient practices.

Footnotes

  • Letters not directly related to articles published in Clinical Medicine and presenting unpublished original data should be submitted for publication in this section. Clinical and scientific letters should not exceed 500 words and may include one table and up to five references.

  • © 2012 Royal College of Physicians

References

  1. ↵
    1. Dhawan SS,
    2. Quyyumi AA
    . Rheumatoid arthritis and cardiovascular disease. Curr Atheroscler Rep 2008;10:128–33doi:10.1007/s11883-008-0019-x
    OpenUrlCrossRefPubMed
  2. ↵
    1. Silman AJ,
    2. Newman J,
    3. Macgregor AJ
    . Cigarette smoking increases the risk of rheumatoid arthritis: Results from a nationwide study of disease-discordant twins. Arthritis Rheum 1996;39:732–5doi:10.1002/art.1780390504
    OpenUrlPubMed
  3. ↵
    1. Moraitis D,
    2. Du B,
    3. De Lorenzo MS,
    4. et al
    . Levels of cyclooxygenase-2 are increased in the oral mucosa of smokers: evidence for the role of epidermal growth factor receptor and its ligands. Cancer Res 2005;65:664–70
    OpenUrlAbstract/FREE Full Text
  4. ↵
    1. Majka DS
    . Cigarette smoking and the risk of systemic lupus erythematosus and rheumatoid arthritis. Ann Rheum Dis 2006;65:561–3doi:10.1136/ard.2005.046052
    OpenUrlFREE Full Text
  5. ↵
    1. Pedersen M,
    2. Jacobsen S,
    3. Garred P,
    4. et al
    . Strong combined gene-environment effects in anti-cyclic citrullinated peptide-positive rheumatoid arthritis: a nationwide case-control study in Denmark. Arthritis Rheum 2007;56:1446–53doi:10.1002/art.22597
    OpenUrlCrossRefPubMed
  6. ↵
    1. Mahdi H,
    2. Fisher BA,
    3. Källberg H,
    4. et al
    . Specific interaction between genotype, smoking and autoimmunity to citrullinated alpha-enolase in the etiology of rheumatoid arthritis. Nat Genet 2009;41:1319–24doi:10.1038/ng.480
    OpenUrlCrossRefPubMed
  7. ↵
    1. Saevarsdottir S,
    2. Wedrén S,
    3. Seddighzadeh M,
    4. et al
    . Patients with early rheumatoid arthritis who smoke are less likely to respond to treatment with methotrexate and tumor necrosis factor inhibitors: Observations from the Epidemiological Investigation of Rheumatoid Arthritis and the Swedish Rheumatology Reg. Arthritis Rheum 2011;63:26–36doi:10.1002/art.27758
    OpenUrlCrossRefPubMed
  8. ↵
    Söderlin MK, Petersson IF, Geborek P. The effect of smoking on response and drug survival in rheumatoid arthritis patients treated with their first anti-TNF drug. Scand J Rheumatol 2012;41:1–9doi:10.3109/03009742.2012.677857
    OpenUrlPubMed
  9. ↵
    1. Ayanian JZ,
    2. Cleary PD
    . Perceived risks of heart disease and cancer among cigarette smokers. JAMA 1999;281:1019–21doi:10.1001/jama.281.11.1019
    OpenUrlCrossRefPubMed
Back to top
Previous articleNext article

Article Tools

Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Citation Tools
Smoking: keeping the joint alight
Maria Mouyis, Sonya Abraham
Clinical Medicine Aug 2012, 12 (4) 399-400; DOI: 10.7861/clinmedicine.12-4-399

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Share
Smoking: keeping the joint alight
Maria Mouyis, Sonya Abraham
Clinical Medicine Aug 2012, 12 (4) 399-400; DOI: 10.7861/clinmedicine.12-4-399
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Footnotes
    • References
  • Info & Metrics

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

Letters to the Editor

  • Response
  • Functional disorders and chronic pain
  • A further explanation for chest pain without visible coronary artery disease
Show more Letters to the Editor

Clinical and Scientific Letters

  • Does ultrasound-guided peripheral cannulation training for junior doctors reduce missed intravenous antibiotics doses? A teaching programme for foundation doctors in an acute medical unit
  • Unexpected deaths following discharge of medical patients from hospital
  • Promoting electric vehicle uptake, a job for the NHS?
Show more Clinical and Scientific Letters

Similar Articles

Navigate this Journal

  • Journal Home
  • Current Issue
  • Ahead of Print
  • Archive

Related Links

  • ClinMed - Home
  • FHJ - Home
clinmedicine Footer Logo
  • Home
  • Journals
  • Contact us
  • Advertise
HighWire Press, Inc.

Follow Us:

  • Follow HighWire Origins on Twitter
  • Visit HighWire Origins on Facebook

Copyright © 2021 by the Royal College of Physicians