Smoking, Smoking Cessation, and Disease Activity in a Large Cohort of Patients with Rheumatoid Arthritis

Objective. While cigarette smoking is the best-studied environmental factor contributing to rheumatoid arthritis (RA), no study to date has examined the influence of smoking cessation on disease activity. We examined this relationship in an observational cohort of patients with RA in the United States. Methods. Patients enrolled in the Consortium of Rheumatology Researchers of North America registry (CORRONA) were stratified into never, former, and current smokers at enrollment. Current smokers were further stratified into continued and ceased smoking groups during their followup in the registry. The primary outcome was change in Clinical Disease Activity Index (CDAI) at last visit in a multivariate, random-effects regression model accounting for multiple timepoints. Results. At last visit, there was no significant change in CDAI between ceased smokers and continued smokers (coefficient -0.00091, SE 0.0033, p = 0.7834). The study did confirm prior cross-sectional studies that current smokers have worse disease activity than former or never smokers. Conclusion. In the short term, smoking cessation did not appear to influence change in disease activity over time. (First Release March 152012; J Rheumatol 2012;39:904-9; doi:10.3899/jrheum.110852)