Everyone knows that smoking cigarettes is bad for your health — it’s pretty much common knowledge at this point. Aside from cancer, emphysema, and dangers for pregnant women (not to mention the stench! The yellow teeth!) did you know that smoking can raise your risk of rheumatoid arthritis and also can trigger autoimmunity?

Over the years, a lot of research has been done on how smoking could affect the health of someone with rheumatoid arthritis or similar autoimmune conditions.

As you could imagine, the results were not in favor of smoking.

If you still don’t believe me, here are just a few study outcomes to set you on the path to hopefully kick the habit:

* A 2010 study published in the December issue of Arthritis & Rheumatism found that “African-Americans who smoke heavily – defined as at least a pack-a-day habit for at least 10 years – double their risk of getting rheumatoid arthritis, or RA. On the flip side, researchers say about one in six new cases of RA in African-American patients could be avoided if they stopped or significantly limited their cigarette smoking.”

* Another study, also from 2010, published in the December issue of Annals of Rheumatic Diseases, stated that “Smoking accounts for more than a third of cases of the most common form of RA and for more than 50% of RA diagnoses among people who are genetically susceptible to the development of this disease. RA is an autoimmune disease that occurs when the body’s immune system engages in friendly fire against the joints and bones, resulting in inflammation, pain, and mobility problems as the disease progresses. The effects of smoking are not as pronounced on RA risk as they are on lung cancer risk. Studies show that smoking is responsible for about 90% of lung cancer cases, but smoking’s effect on RA is similar to its effect on heart disease risk.” According to the study, “RA risk is related to how much a person smokes, how long a person smokes, and the presence of certain antibodies in the blood that are associated with RA, namely ACPA antibodies.”

* In the year 2000, research was presented at the American College of Rheumatology Annual Scientific Meeting:
based on an analysis of the records of more than 30,000 women (age 55-69) enrolled in the Iowa Women’s Health Study since 1986 statistically significant correlations were found between the incidence of elderly onset rheumatoid arthritis and the number of cigarettes smoked per day, and the incidence of elderly onset rheumatoid arthritis and how long the individual was a smoker. It was found that the risk of developing rheumatoid arthritis was nearly double for current smokers compared to non-smokers. The risk of developing rheumatoid arthritis appeared lower for former smokers compared to current smokers but higher than for people who never smoked. Women who had stopped smoking at least 10 years prior to the start of the study did not have an increased risk. An interaction between smoking and the woman’s immune system and/or estrogen level has been suggested. It is thought that smoking may lower the level of estrogen. It has also been observed that smoking raises the level of rheumatoid factor in the body.”

* In 2008, the American College of Rheumatology also presented evidence that quitting smoking could ease pain from rheumatoid arthritis. The study showed reduced discomfort from swollen and tender joints. “While these results are preliminary, it seems that quitting smoking, which would have many other health benefits, also may benefit patients with rheumatoid arthritis,” said Mark Fisher, MD, MPH, of New York University Medical Center’s Hospital for Joint Disease, in a news release. “RA patients who stop smoking may see an improvement in the number of joints that hurt them every day and in how they feel overall.” Smoking is known to increase the risk and severity of rheumatoid arthritis. This study further examined the connection. Of 1,405 people who smoked when they enrolled in a registry of patients with rheumatoid arthritis, 21.1% said they stopped smoking, the researchers said. By the time of their last follow-up visit, disease activity was higher in active smokers than in those who had quit. The numbers of tender and swollen joints were lower in the group of participants who had quit smoking. The results could suggest that stopping smoking can lessen disease activity in people with rheumatoid arthritis.

* In 2011, Everyday Health published an article that said, “what causes autoimmune diseases remain a mystery, but researchers may have found a big piece of the puzzle: studies show that smoking only worsens autoimmune diseases symptoms, but may play a role in actually causing them.”

* In 2006, the Lupus Foundation published an abstract from Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital that said, “Cigarette smoking has been causally linked to the development of multiple autoimmune diseases, including rheumatoid arthritis, systemic lupus erythematosus, multiple sclerosis, Graves’ hyperthyroidism, and primary biliary cirrhosis, among others. We review the known biologic effects of cigarette smoke, in particular its actions on the immune system, and the epidemiologic evidence associating smoking with increased risk of each of these autoimmune diseases. Interactions between cigarette smoking and genetic and immunologic factors, such as the human leukocyte antigen (HLA)shared epitope, rheumatoid factor, anti-cyclic citrullinated peptide antibodies, and anti-double stranded DNA antibodies, may point to mechanisms in disease pathogenesis.”

* In 2009, a study was published in Nature Genetics which said that there is a “specific interaction between genotype, smoking, and autoimmunity to citrullinated a-enolase in the etiology of rheumatoid arthritis.”

* In January of 2011, another study was published in Arthritis & Rheumatism which said, ” Smokers are 50 percent less likely to respond well to treatments in early RA than non-smokers.” You can read more about these very interesting and important findings from Arthritis Today, here.

* In 2012, Arthritis Today Magazine published an article about whether or not smoking triggers autoimmunity in rheumatoid arthritis. According to the piece, “a large body of research persuasively shows the role cigarette smoking can play in RA if the genetic climate is right. Now, scientists are trying to understand how smoking might trigger a particularly aggressive form of RA in certain people.” You can read this very compelling report in its entirety, here.

Additionally, many people with autoimmune conditions also can have a predisposition towards allergies — and smoke, believe it or not, is a top allergen and may trigger or worsen these allergies. Also, heart disease is closely associated with both RA (and lupus) and smoking — so why double the risk? Lastly, people on certain rheumatoid arthritis medications have suppressed immune systems – and people who smoke are at a higher risk for developing things like bronchitis or pneumonia. So be careful!

   As with the topic of diet and weight, the topic of smoking is a sensitive one for many. Like with weight loss, people tend to get defensive if this is an issue that they are presently contending with. This blog post is not written from a place of being judgmental, it is coming from a place of encouraging better health and overall wellness.

Smoking is bad for anyone, but can be a particular matter of concern for anyone living with rheumatoid arthritis or a similar rheumatic or autoimmune disease.

So, the next time you want up, stop and think: is it worth it?

Thanks for reading! Feel free to leave a comment.

And if you need help to quit smoking, here are some resources:

* Become an “ex” –http://www.becomeanex.org/?Cid=G_Q_%20quit%20smoking

* Smokefree – http://www.smokefree.gov/

* Why Quit – http://whyquit.com/

* Quit Tobacco – U Can Quit 2 – http://www.ucanquit2.org/

* American Cancer Society – http://www.cancer.org/Healthy/StayAwayfromTobacco/GuidetoQuittingSmoking/index

* Quit Net – http://www.quitnet.com/qnhomepage.aspx

* Center for Disease Control – http://www.cdc.gov/tobacco/quit_smoking/

There are also many products and options out there – even support groups! – to help you quit smoking. Be sure to ask your doctor!

Stay Well,

Ashley Boynes-Shuck

* pig cartoon by Mark Parisi