Smoking and Other Factors Increase Risk for Rapid Progression in Rheumatoid Arthritis

cigarette in older person's hand
cigarette in older person’s hand
A study found that smoking and BMI may independently influence risk for radiographic progression of RA.

For patients with early rheumatoid arthritis, a history of smoking, presence of rheumatoid factor (RF), anticyclic citrullinated peptides, early erosions, high initial disease activity, and active disease at 1 year increase the risk for rapid radiographic progression (RRP), according to results published in Arthritis Research & Therapy.

The results also indicated that patients with high body mass index (BMI) may have a reduced risk for severe joint damage, which was not explained by differences in disease activity or antibody status.

The study included participants with early rheumatoid arthritis (symptom duration <12 months, n=233). The researchers scored radiographs of participants’ hands and feet according to the modified Sharp-van der Heijde score. They defined RRP as an increase of ≥5 points in Sharp-van der Heijde score per year.

The study researchers collected radiographs from 216 participants at baseline, 206 participants after 1 year of follow-up, and 171 participants after 5 years of follow-up. They found that 22% (n=36) had RRP for up to 5 years. Logistic regression models indicated that RF, anticyclic citrullinated peptides, increased erythrocyte sedimentation rate, or C-reactive protein at baseline predicted RRP over 5 years (odds ratio, 0.26; 95% CI, 0.11-0.63; adjusted for RF, baseline erosions, and erythrocyte sedimentation rate).

Participants who had a history of smoking had a significantly increased risk for RRP up to 5 years, independent of BMI (odds ratio, 3.17; 95% CI, 1.22-8.28; adjusted for BMI).

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After 1-year of follow-up, erosive changes, Disease Activity Score of 28 joints, Health Assessment Questionnaire score, swollen joint count, and patient’s global assessment of disease activity and pain were also significantly associated with RRP up to 5 years.

“The results of this study suggest independent effects of smoking and BMI on the risk of RRP,” the researchers wrote.


Rydell E, Forslind K, Nilsson J, Jacobsson LTH, Turesson C. Smoking, body mass index, disease activity, and the risk of rapid radiographic progression in patients with early rheumatoid arthritis.  Arthritis Res Ther. 2018;20:82.