Recent Research Probes Smoking & the Risk for Autoimmune Disease

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Using the Nurses’ Health Study, Dr. Barbhaiya and Karen Costenbader, MD, along with researchers from Brigham and Women’s Hospital, Boston, also found current—not past—smoking was strongly related to risk for the subtype of SLE associated with anti-double-stranded DNA+.⁴ “The strong and specific association of current smoking with anti-double-stranded DNA seropositive SLE suggest smoking is involved in the pathogenesis of this specific subtype of SLE,” Dr. Barbhaiya says.

Using the Black Women’s Health Study cohort, Drs. Barbhaiya and Costenbader, along with researchers from the Slone Epidemiology Center at Boston University, Boston, also studied the risk of cigarette smoking on SLE development. Their study found that among 59,000 black women, 127 new cases of lupus developed between 1995 and 2015. The risk of SLE was higher by 45% among smokers compared with never smokers; this number did not reach statistical significance. The risk also increased more (not significantly) with a greater number of pack-years of smoking.⁵

Additional studies will help researchers analyze smoking and its effect on rheumatological diseases, says Geeta Nayyar, MD, MBA, rheumatologist and assistant clinical professor of medicine at Florida International University, Miami, and chief innovation officer at TopLineMD.com and Femwell Group Health. “Further studies are needed to analyze the exact effect of smoking on each rheumatic disease separately to really know the sole mechanism of action smoking may have on an individual disease,” she says.

Paradoxical questions are brought on by the research that require further investigation, says Anca D. Askanase, MD, MPH, director and founder, Columbia University Lupus Center, and associate professor of medicine, Division of Rheumatology, Columbia University Irving Medical Center, New York. She points to research that finds smoking increases the risk of psoriatic arthritis (PsA) in the general population but somehow lowers the risk in patients who already have psoriasis. Another confusing finding comes from research indicating a possible protective effect of cigarette smoking for ankylosing spondylitis and RA, Dr. Lai says. However, these findings have been called into question by more recent studies, say Drs. Askanase and Lai.⁶

Benefits that kick in as soon as a person stops smoking include a lower heart rate & a better sense of taste & smell.

How Quitting Helps

Rheumatologists can potentially share information with patients about the benefits that kick in when patients stop smoking, Dr. Rizzo says.

Some of these benefits happen immediately when a person stops. These include a lower heart rate and a better sense of taste and smell. Thinking more long term, the risk for heart disease and other chronic conditions lowers over several years. Fifteen years after a person quits smoking, the risk for heart disease is the same as for a nonsmoker, the Centers for Disease Control and Prevention (CDC) reports.

“Sometimes the tradeoff [with quitting] is increasing weight, but a patient can worry about those extra 10 lbs. later on,” Dr. Rizzo says.

A multi-center, open-label, randomized controlled trial is underway in patients with RA to analyze the effects on disease activity with an intensive smoking cessation program compared with standard care on smoking cessation.⁷ The intensive smoking cessation program will include motivational counseling along with tailored nicotine replacement. The trial will include 150 daily smokers who have RA, but who are in remission or who have low to moderate disease activity, rated by a Disease Activity Score-28 (DAS28) of 5.1 or less. Seventy-five patients will receive the intensive therapy. At three months, researchers will evaluate the patients’ self-reported smoking cessation and achievement of a European League Against Rheumatism (EULAR) clinical response by a DAS28 improvement of 0.6 or greater. Additional follow-ups will take place at three, six and 12 months. The study is slated for completion in June 2019, according to ClinicalTrials.gov.

“Although further studies are needed in this area, the idea that rheumatic disease may be modifiable by behavior change, such as quitting smoking, may provide hope to patients who otherwise feel resigned there is no way to change their disease risk,” Dr. Barbhaiya says.