Impact and Timing of Smoking Cessation on Reducing Risk of Rheumatoid Arthritis Among Women in the Nurses’ Health Studies

Abstract

Objective. To investigate the impact and timing of smoking cessation on developing rheumatoid arthritis (RA) and serologic phenotypes.Methods. We investigated smoking cessation and RA risk in the Nurses' Health Study (NHS) and the NHS II . Smoking exposures and covariates were obtained by biennial questionnaires. Self-reported RA was confirmed by medical record review for American College of Rheumatology/European League Against Rheumatism criteria. Cox regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CIs) for RA serologic phenotypes (all, seropositive, seronegative) according to smoking status, intensity, pack-years, and years since cessation.Results. Among 230,732 women, we identified 1,528 incident cases of RA (63.4% of which were seropositive) during 6,037,151 person-years of follow-up. Compared with never smoking, current smoking increased the risk of all RA (multivariable HR 1.47, 95% CI 1.27-1.72) and seropositive RA (HR 1.67, 95% CI 1.38-2.01) but not seronegative RA (HR 1.20, 95% CI 0.93-1.55). An increasing number of smoking pack-years was associated with an increased trend for the risk of all RA (P < 0.0001) and seropositive RA (P < 0.0001). With increasing duration of smoking cessation, a decreased trend for the risk of all RA was observed (P = 0.009) and seropositive RA (P = 0.002). Compared to recent quitters (<5 years), those who quit ≥30 years ago had an HR of 0.63 (95% CI 0.44-0.90) for seropositive RA. However, a modestly increased risk of RA was still detectable 30 years after quitting smoking (for all RA, HR 1.25 [95% CI 1.02-1.53]; for seropositive RA, HR 1.30 [95% CI 1.01-1.68]; reference, never smoking).Conclusion. These results confirm that smoking is a strong risk factor for developing seropositive RA and demonstrate for the first time that a behavior change of sustained smoking cessation could delay or even prevent seropositive RA.

Харчування Як Чинник Ризику Та Втручання При Ревматичних Захворюваннях

“…It is worth emphasizing that all studies on effects of nutrition as risk factor or intervention in the rheumatic disease should take into account the participants' status of smoking. The results of the analysis of the present evidence allow to consider a complete cessation of smoking the most effective technology of primary prevention of RA (namely of its unfavorable subtype -seropositive RA) [5,30,[34][35][36]. In accordance with the terminology given by the Center for Disease Control and Prevention (www.cdc.gov/nchs/nhis/tobacco/tobacco_glossary.htm; accessed at: 07.07.2019), ever smoker is a person who has smoked at least 100 cigarettes in his or her life.…”

“…the ability to extrapolate its results to the general population, taking into account the biased sample of «predominantly well-educated white women») and internal one (since the intervals for assessing smoking status were at least 2 years). The evidence of effect of smoking cessation on the outcomes in patients with established diagnosis of RA remains weak: by stopping smoking, patients can reduce the risks posed by the disease [30].…”

“…Today, the trigger potential of diets, foods, ingredients and supplements is best studied in RA. Some contribution to this knowledge was made by the results of the US nursing cohort studies Nurses' Health Studies (NHS, NHS II, NHS III) received in 1976-2016 [20,[27][28][29][30][31][32]. They provide evidence of strong inverse correlation between duration of breastfeeding lasting ≥12 months in infant girls and probability of RA development in their adulthood.…”

“…Already in 2019 X. Liu et al [30] represented their analysis of the data from the Nurses' Health Studies. They have proven the following: 1) female-smokers when compared with never smokers have 47 % increased risk of developing RA (HR=1,47; 95 % CI 1,27-1,72), particularly of seropositive subtype (i.е.…”

Measuring ACPA in the general population or primary care: is it useful?

“…One could argue that widespread autoantibody screening makes little sense before a preventive intervention has demonstrated its ability to reduce the incidence of RA. However, even before any pharmacological intervention demonstrates efficacy in preventing RA development, one can claim that there is currently already enough evidence to recommend specific lifestyle modifications in individuals at high risk for the disease 24. The question we will be exploring in this review is whether ACPA could be used as a screening test in a broader general population or primary care setting to identify individuals who could benefit from a preventive intervention.…”