E015 Importance of smoking cessation in rheumatological outcomes

Abstract

Abstract Background/Aims Smoking is a major preventable risk factor for many rheumatological diseases and can influence the severity of symptoms in conditions such as psoriatic arthritis (PsA), ankylosing spondylitis, giant cell arteritis (GCA) and systemic lupus erythematosus (SLE). The increased risk due to smoking is dose dependent. The objective was to identify the proportion of patients with rheumatological conditions who smoke and to ensure that smoking cessation advice is given in line with NICE guidelines. Methods A retrospective qualitative study with data collected from electronic patient records (EPR) between September and November 2022 across multiple rheumatology clinics. Data included age, gender, smoking status, diagnosis, disease duration, comorbidities, treatment, and smoking advice status. Results 459 patients were analysed (68% female), of which 11% were smokers, 6% were ex-smokers, 83% were non-smokers, and 1 vapes regularly. Among the smokers, 72% were female. The median age was 61 years, with a range of 18-91 years. The commonest age range for all patients is 71-80 years, while the commonest age range among smokers was 41-50 years at 28%. The commonest disease duration among smokers is 1-5 years. The most common disease diagnosis among smokers were RA (30%), PsA (19%) and SLE (6%). Regarding disease activity among smokers, 36% had mild, 56% had moderate, and 8% had severe disease activity. Among the 12 patients with respiratory comorbidities; 6 had asthma, and 4 had COPD. Among the 21 patients with cardiovascular comorbidities; 13 had hypertension, and 6 had hypercholesterolaemia. For patients on cDMARDS, 26% were on methotrexate, 11% were on sulfasalazine, 9.4% were on hydroxychloroquine and 2% were on leflunomide. 13% were on prednisolone, while 7.5% had required methylprednisolone injections. 11% were on bDMARDs, most commonly adalimumab. Smoking cessation advice was documented in 4%, whereas 96% had no evidence of any smoking cessation advice. Conclusion This study illustrates the most common age range of smokers in this cohort was 41-50 years (28%), which was almost twice the equivalent national level (14.3% in 45-54 years). Nationally, the most common age range is 25-34 years (15.8%). Patients with rheumatological disease who smoked were of younger age compared to non-smokers, and smoking rates were higher in females compared to males. Smoking cessation advice was only documented in 4% of this cohort. This indicates much scope for improvement, and enhanced disease control in a population with multiple challenges, primarily socioeconomically. VBA (Very Brief Advice) has been shown to be the single most effective and clinically proven preventive action a clinical can give to patients in relation to smoking cessation. The NCSCT (National Centre for Smoking Cessation Training) encourages the 3A’s (ASK, ADVICE, ACT). Disclosure M. Osikoya-Yekini: None. W. Walshe: None. A. Bharadwaj: None. A. Nandagudi: None.