The effect of smoking on mortality risk in RA patients – a 36-year follow-up

This study examined the effect of smoking habits on mortality rates in women with rheumatoid arthritis (RA) over 36 years. The authors concluded that women who quit smoking entirely within 4 years of diagnosis of RA had reduced mortality rates. RA patients who smoked more and for longer were at a significantly higher risk of mortality than individuals without RA. 

Patients with smoking-related conditions such as cancer, diabetes, or heart disease who quit smoking can significantly reduce their risk of mortality by 20 to 50%. Cigarette smoking is considered a risk factor for patients with rheumatoid arthritis (RA). It is the leading cause of cardiovascular (heart and blood vessel) and respiratory diseases that are linked to mortality in RA patients. Previous studies have shown that RA patients who quit smoking can reduce their risk of mortality. However, more longitudinal studies are needed. It is also not known if a diagnosis of RA affects smoking behavior in patients compared to those without RA.

This study included 938 women with RA and 8,951 matched women without RA (comparison group). The authors examined smoking habits and mortality rates in all participants over 36 years.

Among current smokers, 40% of patients with RA quit smoking soon after diagnosis compared to 36.1% of those without RA. The mortality rate was 33.4% in the RA group and 22.8% in the comparison group. Patients with RA who quit smoking entirely had a 42% lower mortality rate compared to RA patients who did not stop smoking. A similar decrease of 53% was seen in those who quit smoking in the comparison group.

Mortality rates were 3.67 times higher in women with RA who smoked higher numbers of cigarettes for a long period of time. In women without RA with similar smoking habits mortality rates were 1.88 times higher. Smoking a high number of cigarettes for a long period after diagnosis of RA was linked to a 37% increase in mortality rates.

The authors concluded that RA patients who quit smoking can lower their risk of mortality. Patients who continue to smoke heavily after diagnosis have a significantly increased risk of mortality.

Data relating to RA disease activity and treatment was not available for all patients and may have had an effect on mortality rates.