• We are sorry, but NCBI web applications do not support your browser and may not function properly. More information
Logo of annrheumdAnnals of the Rheumatic DiseasesVisit this articleSubmit a manuscriptReceive email alertsContact usBMJ
Ann Rheum Dis. Mar 2001; 60(3): 223–227.
PMCID: PMC1753588

Heavy cigarette smoking is strongly associated with rheumatoid arthritis (RA), particularly in patients without a family history of RA


OBJECTIVES—To investigate the potential relation between cumulative exposure to cigarette smoking in patients with or without rheumatoid arthritis (RA) and a positive family history of the disease.
METHODS—239 outpatient based patients with RA were compared with 239 controls matched for age, sex, and social class. A detailed smoking history was recorded and expressed as pack years smoked. Conditional logistic regression was used to calculate the association between RA and pack years smoked. The patients with RA were also interviewed about a family history of disease and recorded as positive if a first or second degree relative had RA. The smoking history at the time of the study of the patients with RA with or without a family history of the disease was compared directly with that of their respective controls. Patients with RA with or without a family history of the disease were also compared retrospectively for current smoking at the time of disease onset.
RESULTS—An increasing association between increased pack years smoked and RA was found. There was a striking association between heavy cigarette smoking and RA. A history for 41-50 pack years smoked was associated with RA (odds ratio (OR) 13.54, 95% confidence interval (95% CI) 2.89 to 63.38; p<0.001). The association between ever having smoked and RA was modest (OR 1.81, CI 1.22 to 2.19; p=0.002). Furthermore, cigarette smoking in the patients with RA without a positive family history of RA was more prevalent than in the patients with a positive family history of RA for ever having smoked (72% v 54%; p=0.006), the number of pack years smoked (median 25.0 v 4.0; p<0.001), and for smoking at the time of disease onset (58% v 39%; p=0.003).
CONCLUSIONS—Heavy cigarette smoking, but not smoking itself, is strongly associated with RA requiring hospital follow up and is markedly more prevalent in patients with RA without a family history of RA.

Full Text

The Full Text of this article is available as a PDF (114K).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Lawrence JS. Heberden Oration, 1969. Rheumatoid arthritis--nature or nurture? Ann Rheum Dis. 1970 Jul;29(4):357–379. [PMC free article] [PubMed]
  • Ollier WE, MacGregor A. Genetic epidemiology of rheumatoid disease. Br Med Bull. 1995 Apr;51(2):267–285. [PubMed]
  • Koumantaki Y, Giziaki E, Linos A, Kontomerkos A, Kaklamanis P, Vaiopoulos G, Mandas J, Kaklamani E. Family history as a risk factor for rheumatoid arthritis: a case-control study. J Rheumatol. 1997 Aug;24(8):1522–1526. [PubMed]
  • Fischer KM. Hypothesis: tobacco use is a risk factor in rheumatoid arthritis. Med Hypotheses. 1991 Feb;34(2):116–117. [PubMed]
  • Seldin MF, Amos CI, Ward R, Gregersen PK. The genetics revolution and the assault on rheumatoid arthritis. Arthritis Rheum. 1999 Jun;42(6):1071–1079. [PubMed]
  • Uhlig T, Hagen KB, Kvien TK. Current tobacco smoking, formal education, and the risk of rheumatoid arthritis. J Rheumatol. 1999 Jan;26(1):47–54. [PubMed]
  • Khoury MJ, Beaty TH, Newill CA, Bryant S, Cohen BH. Genetic-environmental interactions in chronic airways obstruction. Int J Epidemiol. 1986 Mar;15(1):65–72. [PubMed]
  • Doll R, Peto R, Wheatley K, Gray R, Sutherland I. Mortality in relation to smoking: 40 years' observations on male British doctors. BMJ. 1994 Oct 8;309(6959):901–911. [PMC free article] [PubMed]
  • Howard G, Wagenknecht LE, Burke GL, Diez-Roux A, Evans GW, McGovern P, Nieto FJ, Tell GS. Cigarette smoking and progression of atherosclerosis: The Atherosclerosis Risk in Communities (ARIC) Study. JAMA. 1998 Jan 14;279(2):119–124. [PubMed]
  • Karlson EW, Lee IM, Cook NR, Manson JE, Buring JE, Hennekens CH. A retrospective cohort study of cigarette smoking and risk of rheumatoid arthritis in female health professionals. Arthritis Rheum. 1999 May;42(5):910–917. [PubMed]
  • Jonsson B, Larsson SE. Hand function and total locomotion status in rheumatoid arthritis. An epidemiologic study. Acta Orthop Scand. 1990 Aug;61(4):339–343. [PubMed]
  • Saag KG, Cerhan JR, Kolluri S, Ohashi K, Hunninghake GW, Schwartz DA. Cigarette smoking and rheumatoid arthritis severity. Ann Rheum Dis. 1997 Aug;56(8):463–469. [PMC free article] [PubMed]
  • Arnett FC, Edworthy SM, Bloch DA, McShane DJ, Fries JF, Cooper NS, Healey LA, Kaplan SR, Liang MH, Luthra HS, et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum. 1988 Mar;31(3):315–324. [PubMed]
  • Mills CM, Srivastava ED, Harvey IM, Swift GL, Newcombe RG, Holt PJ, Rhodes J. Smoking habits in psoriasis: a case control study. Br J Dermatol. 1992 Jul;127(1):18–21. [PubMed]
  • Rosso S, Joris F, Zanetti R. Risk of basal and squamous cell carcinomas of the skin in Sion, Switzerland: a case-control study. Tumori. 1999 Nov-Dec;85(6):435–442. [PubMed]
  • Tenkate TD. Occupational exposure to ultraviolet radiation: a health risk assessment. Rev Environ Health. 1999 Oct-Dec;14(4):187–209. [PubMed]
  • Symmons DP, Bankhead CR, Harrison BJ, Brennan P, Barrett EM, Scott DG, Silman AJ. Blood transfusion, smoking, and obesity as risk factors for the development of rheumatoid arthritis: results from a primary care-based incident case-control study in Norfolk, England. Arthritis Rheum. 1997 Nov;40(11):1955–1961. [PubMed]
  • Heliövaara M, Aho K, Aromaa A, Knekt P, Reunanen A. Smoking and risk of rheumatoid arthritis. J Rheumatol. 1993 Nov;20(11):1830–1835. [PubMed]
  • Voigt LF, Koepsell TD, Nelson JL, Dugowson CE, Daling JR. Smoking, obesity, alcohol consumption, and the risk of rheumatoid arthritis. Epidemiology. 1994 Sep;5(5):525–532. [PubMed]
  • Gran JT, Husby G, Thorsby E. The association between rheumatoid arthritis and the HLA antigen DR4. Ann Rheum Dis. 1983 Jun;42(3):292–296. [PMC free article] [PubMed]
  • Deighton C. Smoke gets in your joints? Ann Rheum Dis. 1997 Aug;56(8):453–454. [PMC free article] [PubMed]
  • Wolfe F. The effect of smoking on clinical, laboratory, and radiographic status in rheumatoid arthritis. J Rheumatol. 2000 Mar;27(3):630–637. [PubMed]
  • Halldórsdóttir HD, Jónsson T, Thorsteinsson J, Valdimarsson H. A prospective study on the incidence of rheumatoid arthritis among people with persistent increase of rheumatoid factor. Ann Rheum Dis. 2000 Feb;59(2):149–151. [PMC free article] [PubMed]
  • Tuomi T, Heliövaara M, Palosuo T, Aho K. Smoking, lung function, and rheumatoid factors. Ann Rheum Dis. 1990 Oct;49(10):753–756. [PMC free article] [PubMed]
  • Kvalvik AG, Jones MA, Symmons DP. Mortality in a cohort of Norwegian patients with rheumatoid arthritis followed from 1977 to 1992. Scand J Rheumatol. 2000;29(1):29–37. [PubMed]
  • Doll R. Uncovering the effects of smoking: historical perspective. Stat Methods Med Res. 1998 Jun;7(2):87–117. [PubMed]
  • Silman AJ. Recent trends in rheumatoid arthritis. Br J Rheumatol. 1986 Nov;25(4):328–330. [PubMed]

Articles from Annals of the Rheumatic Diseases are provided here courtesy of BMJ Group


Related citations in PubMed

See reviews...See all...

Cited by other articles in PMC

See all...


  • MedGen
    Related information in MedGen
  • PubMed
    PubMed citations for these articles

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...