Effects of smoking on the clinical phenotype and response to treatment in rheumatoid arthritis

Abstract

Smoking is the most studied and widely accepted environmental risk factor for the development of seropositive rheumatoid arthritis, especially in subjects with genetic susceptibility (shared epitope carriers). However, the effect of smoking on aspects of rheumatoid arthritis, such as disease presentation, inflammatory activity, disability and joint damage (radiographic progression), is not clear. Recent data strongly suggest a poor response to methotrexate and TNF antagonists in smokers. We review and analyze the current literature on the relationship between smoking and the clinical phenotype and outcomes of rheumatoid arthritis.