AB0364 CIGARETTE SMOKING AMONGST RHEUMATOID ARTHRITIS PATIENTS IN A TERTIARY CENTER IN SOUTH AFRICA

Abstract

BackgroundCigarette smoking is associated with poorer outcomes amongst rheumatoid arthritis (RA) sufferers, with poorer disease control, increased extra-articular complications and more comorbidities[1]. There are currently no data from sub-Saharan Africa.ObjectivesTo describe the prevalence of cigarette smoking, and explore disease control, comorbidities, extra-articular disease and attitudes of smokers to their habit amongst RA patients in an outpatient clinic at tertiary level public hospital in South Africa. Further, we asked patients about the impact of prohibition during the COVID pandemic.MethodsA cross-sectional study of consenting adult outpatients with RA meeting the EULAR/ACR 2010 Classification Criteria. Demographic, clinical and patient-reported outcome measures (PROMs) including the Health Assessment Questionnaire-Disability Index (HAQ-DI), FACIT-fatigue scale, Brief Pain Inventory-short form and Hospital Anxiety and Depression Scale (HADs) together with a questionnaire about smoking and Fagerström test for nicotine dependence were collated.ResultsOf 632 patients (536 females), the mean (SD) age and disease duration were 55.4 (13.0) and 10.1 (9.3) years. A poor socio-economic setting (SES) (defined using a pooled index) was noted in 67.0%. The mean (SD) Clinical Disease Activity Index (CDAI) and HAQ-DI were 14.3 (11.8) and 1.5 (0.7). The cohort included 218 (34,5%) smokers, and 89 (14.1%) ex-smokers, and more males smoked (49/218 vs 47/414, p=0,0002). Compared to non- or ex-smokers, smokers had lower BMI (29.7 vs 32.7 (p= 0.01), higher anxiety scores (8.8 vs 8.0, p=0,048) and incidence of COPD (7.8 % vs 1.0%, p< 0.005). The vast majority (74.1%) had two or more comorbidities, and the commonest comorbidities were hypertension, dyslipidaemia and diabetes. There were no significant differences in age of RA onset, disease duration, SES, number of comorbidities, CDAI nor its individual components, extra-articular diseases nor in HAQ-DI, FACIT, depression or pain scores.Of 160 patients who completed the smoking questionnaire, 83 (51.9%) believed smoking worsened their arthritis, and 119 (74.4%) reported receiving smoking cessation advice at the RA clinic. Participants’ most common reasons for smoking were emotional support (32.2%), nicotine craving (21.7%) and pain control (27.3%). Although 50.1% felt that living with RA made quitting difficult, 86.9% had considered quitting, and almost half (45.6%) had previously quit for more than 3 months. The Fagerström score revealed mild, moderate and severe nicotine dependence in 67.5%, 24.4%, and 7.5% respectively. The Fageström score was significantly associated with anxiety (r=0.2, p=0.02) and depression (r=0.28, p<0.005).Smoking prohibition during COVID pandemic resulted in 60.0% (96) patients quitting or reducing cigarette consumption. Patients felt that helpful services from their RA team might include referral to a smoking cessation clinic (48.1%) and availability of more reading material (36.1%).ConclusionIn this cohort of indigent RA patients, a third of RA patients are smokers, with higher prevalence in males, and associated with lower BMI and higher anxiety scores but with no differences in disease parameters or other PROM’s. Smoking is a modifiable risk factor, of great importance given the high prevalence of comorbidities in the cohort. Only half the cohort were aware that smoking worsened their RA disease control. The mild to moderate nicotine dependence in this cohort, together with patients’ willingness to quit should encourage both patient and health care providers to positively engage in smoking cessation.Reference[1] Gwinnutt JM et al Best Pract Res Clin Rheumatol. 2020Acknowledgements:NIL.Disclosure of InterestsNone Declared.