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Smoking and RA: What Are the Effects?

Medically reviewed by Diane M. Horowitz, M.D.
Posted on April 27, 2021

Smoking has many adverse health effects, including links to cancer, cardiovascular disease, and pulmonary disease. For those with rheumatoid arthritis (RA), an inflammatory disease of the joints, smoking can worsen symptoms and lower medication effectiveness. Smoking is also linked to developing RA. If you smoke and have RA, it’s important to understand the adverse effects of smoking and the benefits of quitting.

Smoking and RA Risk

Both genetic and environmental factors, such as smoking, are involved in the development of RA. Several meta-analysis studies have identified smoking as an important RA risk factor, with the prevalence of RA nearly twice as high for smokers than for nonsmokers. Both past and current smoking are connected to a person’s RA susceptibility. However, the increased risk of rheumatoid arthritis is more pronounced in heavy smokers and in people who have been smoking for 20 years or more.

RA is an autoimmune disease. In people with RA, the body’s immune system attacks healthy tissues, including those in the joints. Researchers believe the interaction between cigarette smoke and the body’s immune system is related to the increased incidence of RA in smokers.

Research shows that smoking increases oxidative stress, cell death, and inflammation in the body. Smoking is also linked to genetic alterations that increase the risk of RA. Together, these smoking-induced changes contribute to the abnormal immune system behavior that leads to the development of rheumatoid arthritis.

The autoimmune response seen in RA involves the production of antibodies against proteins in the body, called autoantibodies. The presence of autoantibodies is a strong predictor of RA disease progression and severity. Two such autoantibodies are produced against proteins called rheumatoid factor (RF) and cyclic citrullinated peptide (CCP). People who test positive for these autoantibodies are considered to have seropositive RA and often have more severe symptoms and joint damage than those who are seronegative.

Cigarette smoking is associated with the increased production of anti-RF and anti-CCP antibodies, which increase the risk of RA. Researchers from the Brigham and Women’s Hospital rheumatology division found that smoking cessation reduces the risk of developing seropositive RA by up to 37 percent. The risk of developing anti-CCP antibodies is particularly high in people who are genetically susceptible to RA who also smoke cigarettes. This genetic susceptibility is linked to a particular genetic variant called HLA-DRB1, which accounts for two-thirds of the genetic risk of RA.

Smoking and RA Symptoms

Smokers may experience more severe arthritis symptoms, including joint pain, stiffness, and swelling. This increased symptom severity is true for all arthritis types, including RA, osteoarthritis, and psoriatic arthritis. Over time, RA joint damage leads to collagen breakdown, joint deformities, and functional difficulties. Smokers are also less likely to experience RA remission and more likely to develop rheumatoid arthritis-associated interstitial lung disease.

In early RA development, cells lining the joints produce inflammatory proteins called cytokines. These inflammatory cytokines contribute to progressive joint destruction seen in RA. Tobacco smoke increases the production of these inflammatory cytokines, worsening RA symptoms and joint damage.

One study found that both current and past smokers had increased disease activity and more joint damage than those who never smoked. In addition, individuals without a detoxifying gene called GSTM1 had higher levels of anti-RF antibodies. High anti-RF antibody levels have a significant association with severe RA.

Smoking also increases the risk of death in those with RA. One study found that, over five years, death rates for smokers were nearly twice that of nonsmokers. Heart disease was the leading cause of death in this study. Fortunately, the death risk falls significantly after quitting smoking.

Smoking and RA Medications

Importantly, smoking decreases the effectiveness of some drugs used to treat rheumatoid arthritis. Studies show that smoking decreases the response to disease-modifying antirheumatic drugs (DMARDs), such as methotrexate, and biologic medications, such as tumor necrosis factor (TNF) inhibitors. By decreasing the effectiveness of these critical rheumatoid arthritis medications, smoking can drive more active disease and decrease remission rates.

Resources To Quit Smoking

Quitting smoking has numerous health benefits, including increased life expectancy, lowered risk of cancer, stroke, and heart attack, and improved quality of life. For those with RA, quitting smoking is a vital part of successfully managing symptoms and disease progression.

Although quitting smoking is challenging, there are many helpful resources. Talk to your rheumatologist or other health care providers about your smoking history, current smoking status, and strategies to help you quit.

Smoking cessation resources include:

  • Using medications such as nicotine replacements or prescription pills
  • Receiving support from friends, family, and other loved ones
  • Seeking individual or group counseling
  • Formulating a plan, including setting a quit date
  • Using free government resources, such as smokefree.gov

Members of myRAteam Discuss Quitting Smoking

Stopping smoking can be challenging. Some members of myRAteam have shared their journey and helped support others looking to quit. “I know you have probably heard it a thousand times, but stopping the cigarettes will help the meds work better and cause less damage.”

Another member wrote, “You can do it!” A third member noted, “I have been smoke-free for over 10 years now. You have to make up your mind and do it.”

Talk With Others Who Understand

By joining myRAteam, the social network for people with rheumatoid arthritis and their loved ones, you can connect with more than 149,000 members who understand life with RA. Every day, members come together to ask questions, give advice, and share their stories.

Are you a current smoker, or have you quit smoking to help manage your RA? Share your experience in the comments below, or share your story on myRAteam.

Posted on April 27, 2021

A myRAteam Member

It seems as though smoking is like letting the horse out the barn door. While quitting certainly has its health benefits, the only advantage I saw regarding RA was certain meds working better. I quit… read more

posted June 24, 2023
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Diane M. Horowitz, M.D. is an internal medicine and rheumatology specialist. Review provided by VeriMed Healthcare Network. Learn more about her here.
Candace Crowley, Ph.D. received her doctorate in immunology from the University of California, Davis, where her thesis focused on immune modulation in childhood asthma. Learn more about her here.

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