Abstract
IntroductionWhereas the overall association between smoking and rheumatoid arthritis (RA) must be regarded as established, considerably less is known about how much smoking is needed to increase the risk of RA, that is, the effect of smoking intensity, duration and cessation.MethodsThe Swedish Mammography Cohort, including 34,101 women aged 54 to 89 years, was followed up from January 1, 2003 through December 31, 2010 (219 RA cases identified). Relative risks (RR) and their 95% confidence intervals (CI) were estimated as rate ratios using Cox proportional hazards model.ResultsThere was a statistically significant association between smoking intensity (RR comparing 1 to 7 cigarettes/day vs never smoking 2.31 (95% CI: 1.59, 3.36)) as well as duration of smoking (comparing 1 to 25 years vs never smoking RR = 1.60 (95% CI: 1.07, 2.38)) and risk of RA. Compared to never smokers, the risk was still significantly elevated 15 years after smoking cessation (RR = 1.99 (95% CI: 1.23, 3.20)). However, among former smokers, the risk of RA seemed to be decreasing over time since stopping smoking: women who stopped smoking 15 years before the start of the follow-up had 30% lower risk of RA compared to those who stopped only a year before start of the follow-up (RR = 0.70 (95% CI: 0.24,2.02)).ConclusionsThis prospective study highlights that even light cigarette smoking is associated with increased risk of RA in women and that smoking cessation may reduce, though not remove, this risk.
Highlights
Whereas the overall association between smoking and rheumatoid arthritis (RA) must be regarded as established, considerably less is known about how much smoking is needed to increase the risk of RA, that is, the effect of smoking intensity, duration and cessation
Former and current smokers were generally younger and were drinking more alcohol compared to never smokers
Intensity of smoking was similar among current and former smokers, while the duration of smoking was almost double among current smokers
Summary
Whereas the overall association between smoking and rheumatoid arthritis (RA) must be regarded as established, considerably less is known about how much smoking is needed to increase the risk of RA, that is, the effect of smoking intensity, duration and cessation. Previous studies have mainly focused on establishing this association and assessed smoking status (current, former, and never smoker) [1,4,7,9,10,14,15,16,17,18,19,20] and pack-years of smoking [2,3,5,6,11,12,13,18,19], while less attention was given to intensity [6,8,16,18,20,21] and/or duration of smoking [6,18,21] Results on these aspects of cigarette smoking have so far indicated that the risk of developing RA increases in a dose-response manner with the intensity and the duration of smoking. Those results showed a decrease in risk 10 to 20 years after smoking cessation
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