Connect with others who understand.

sign up log in
Resources
About myRAteam

Smoking and RA: What Are the Effects?

Posted on April 27, 2021
Medically reviewed by
Diane M. Horowitz, M.D.
Article written by
Candace Crowley, Ph.D.

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.

All updates must be accompanied by text or a picture.
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.

Related articles

The risk for developing rheumatoid arthritis (RA) is associated with many factors, including...

Are Race and Ethnicity Risk Factors in Rheumatoid Arthritis?

The risk for developing rheumatoid arthritis (RA) is associated with many factors, including...
If you’re living with rheumatoid arthritis (RA), you may also have a skin condition called...

Does Having Eczema Raise the Risk for Developing Rheumatoid Arthritis?

If you’re living with rheumatoid arthritis (RA), you may also have a skin condition called...
Rheumatoid arthritis (RA) is an autoimmune inflammatory arthritis that affects about 1 percent to...

Do Infections Trigger the Development of Rheumatoid Arthritis?

Rheumatoid arthritis (RA) is an autoimmune inflammatory arthritis that affects about 1 percent to...
Growing evidence suggests the microbiome of people’s guts — our gastrointestinal (GI) tracts —...

Is Gut Health a Factor in Developing Rheumatoid Arthritis?

Growing evidence suggests the microbiome of people’s guts — our gastrointestinal (GI) tracts —...
Rheumatoid arthritis (RA) is an autoimmune disease that causes the body’s immune system to attack...

Why Are Women More Likely To Develop Rheumatoid Arthritis?

Rheumatoid arthritis (RA) is an autoimmune disease that causes the body’s immune system to attack...
Rheumatoid arthritis (RA) is an autoimmune disease that occurs when the immune system attacks the...

What Causes Rheumatoid Arthritis?

Rheumatoid arthritis (RA) is an autoimmune disease that occurs when the immune system attacks the...

Recent articles

Some people living with rheumatoid arthritis (RA) wonder whether they should wear medical alert...

Medical Alert Bracelets and RA: Do You Need Alert Jewelry?

Some people living with rheumatoid arthritis (RA) wonder whether they should wear medical alert...
Some people with rheumatoid arthritis (RA) choose to limit or eliminate certain foods from their...

3 Reasons To Avoid Sugar If You Have Rheumatoid Arthritis

Some people with rheumatoid arthritis (RA) choose to limit or eliminate certain foods from their...
For people living with rheumatoid arthritis (RA), joint pain can be a common aspect of day-to-day...

Collarbone Pain and RA: What It Feels Like and Tips for Managing

For people living with rheumatoid arthritis (RA), joint pain can be a common aspect of day-to-day...
Rheumatoid arthritis (RA) can become a financial burden with expensive treatments and medical...

Nonprofit Resources for Affording Rheumatoid Arthritis Treatment

Rheumatoid arthritis (RA) can become a financial burden with expensive treatments and medical...
If you have rheumatoid arthritis (RA), you may have heard about kratom — an herbal supplement...

Kratom for Rheumatoid Arthritis: Is It Safe and Can It Help?

If you have rheumatoid arthritis (RA), you may have heard about kratom — an herbal supplement...
When most people think of rheumatoid arthritis (RA), they imagine joint pain affecting the wrists...

Can Rheumatoid Arthritis Cause Tailbone Pain?

When most people think of rheumatoid arthritis (RA), they imagine joint pain affecting the wrists...
myRAteam My rheumatoid arthritis Team

Thank you for subscribing!

Become a member to get even more:

sign up for free

close