Rheumatology Advance Access originally published online on January 10, 2006
Rheumatology 2006 45(6):734-740; doi:10.1093/rheumatology/kei240
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The effects of tobacco smoking and rheumatoid factor seropositivity on disease activity and joint damage in early rheumatoid arthritis
1 Department of Immunology, 2 Medicine and 3 Radiology and 4 Office of the Chief Medical Executive, Landspitali University Hospital, Reykjavik, Iceland.
Correspondence to: A. Vikingsson, Department of Medicine, Section of Rheumatology, Landspitali University Hospital, 101 Reykjavik, Iceland. E-mail: arnor{at}landspitali.is
Objective. To study the effect of tobacco smoking and rheumatoid factor (RF) isotypes on disease activity and joint damage in early rheumatoid arthritis (RA).
Methods. One hundred early RA patients were followed prospectively for 2 yr. They were evaluated at recruitment and at 6 and 24 months. Sociodemographic information included smoking history, and radiographs of hands and feet were obtained. RF was monitored by IgM- and IgA-specific RF enzyme-linked immunosorbent assay and by agglutination, and serial measurements were also obtained for C-reactive protein. The influence of tobacco smoking and RF positivity on disease outcome was evaluated using multivariate analysis. Covariates for the regression analysis included sex, age, coffee consumption and IgA-RF positivity.
Results. A gradient of increase in disease activity was observed from never smokers to former smokers to current smokers during the 2 yr of observation, defined by number of swollen joints (SJC), tender joints (TJC) and visual analogue scale for pain (P<0.001, P=0.02 and P=0.005, respectively), but smoking status did not influence radiological progression. Ever smokers were more often IgA RF positive (P<0.05). IgA RF-positive patients had more active disease (SJC P=0.002, TJC P=0.01) and showed more radiological progression (P<0.0001) compared with IgA RF-negative patients. Of the RF-positive patients 22% had elevated IgM RF without IgA RF and these patients showed similar disease activity and radiological joint progression to the RF-negative patients. None of these associations were explained by possible confounders.
Conclusion. Tobacco smoking has an adverse effect on patients with early RA and this is possibly immunologically mediated. IgM RF does not predict poorer prognosis in RA unless it is associated with a concomitant elevation of IgA RF.
KEY WORDS: Early rheumatoid arthritis, Smoking, Rheumatoid factor isotypes, Disease activity, Joint damage
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