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Ann Rheum Dis. 2014 Jul;73(7):1384-7. doi: 10.1136/annrheumdis-2013-203940. Epub 2014 Jan 3.

Smoking as a risk factor for the radiological severity of rheumatoid arthritis: a study on six cohorts.

Author information

1
Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
2
Section of Rheumatology, Department of Clinical Sciences, Lund University, Lund, Sweden Department of Rheumatology, Skåne University Hospital, Lund, Sweden.
3
Department of Rheumatology and Center for Rheumatology Research, Landspítali-The National University Hospital of Iceland, Reykjavik, Iceland.
4
R and D Centre, Spenshult Hospital, Oskarström, Sweden Section of Rheumatology, Department of Clinical Sciences, Lund University, Sweden for the BARFOT study group, Lund, Sweden.
5
Section of Rheumatology, Department of Clinical Sciences, Lund University, Sweden for the BARFOT study group, Lund, Sweden Section of Rheumatology, Department of Medicine, Helsingborg's lasarett, Helsingborg, Sweden.
6
Feinstein Institute for Medical Research and North Shore-Long Island Jewish Health System, Manhasset, New York, USA.
7
Section of Rheumatology, Department of Clinical Sciences, Lund University, Sweden for the BARFOT study group, Lund, Sweden.

Abstract

BACKGROUND:

Smoking is a risk factor for the development of anti -citrullinated protein antibodies (ACPA) positive rheumatoid arthritis (RA). Whether smoking predisposes to severe joint damage progression is not known, since deleterious, protective and neutral observations have been made.

OBJECTIVE:

To determine the effect of smoking on joint damage progression.

METHODS:

Smoking status was assessed in 3158 RA patients included in six cohorts (Leiden Early Arthritis Clinic (Leiden-EAC), BARFOT, Lund, Iceland, NDB and Wichita). In total 9412 radiographs were assessed. Multivariate normal regression and linear regression analyses were performed. Data were summarised in a random effects inverse variance meta-analysis.

RESULTS:

When comparing radiological progression for RA patients that were never, past and current smokers, smoking was significantly associated with more severe joint damage in Leiden-EAC (p=0.042) and BARFOT (p=0.015) RA patients. No significant associations were found in the other cohorts, though a meta-analysis on the six cohorts showed significantly more severe joint damage progression in smokers (p=0.01). Since smoking predisposes to ACPA, analyses were repeated with ACPA as additional adjustment factor. Then the association was lost (meta-analysis p=0.29).

CONCLUSIONS:

This multi-cohort study indicated that the effect of smoking on joint damage is mediated via ACPA and that smoking is not an independent risk factor for radiological progression in RA.

KEYWORDS:

Ant-CCP; Outcomes research; Rheumatoid Arthritis; Smoking

PMID:
24389296
DOI:
10.1136/annrheumdis-2013-203940
[Indexed for MEDLINE]

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