A Wayne State University School of Medicine project aimed at raising awareness of the harmful effects of smoking in patients with rheumatoid arthritis has secured a $75,000 award of support from the Blue Cross Blue Shield of Michigan Foundation.
Rheumatoid arthritis is a painful autoimmune disease characterized by chronic inflammation of the synovial membrane, the membrane that lines joints. Uncontrolled RA can cause permanent joint damage, decreased mobility and a decline in quality of life.
Smoking is the most important modifiable environmental risk factor in the pathogenesis of the disease, with several previous studies linking it to increased disease activity, decreased response to therapy, a greater need for conventional and biological treatment, an increased incidence of rheumatoid nodules and as an independent factor of radiographic progression of the disease. Smokers also experience increased musculoskeletal pain compared to nonsmokers with musculoskeletal pain, accelerated atherogenesis and increased cardiovascular mortality.
"Smoking has been known to be an important risk factor for the development of rheumatoid arthritis and it has been associated with positive antibodies and extra articular manifestations, but no prospective study has looked at the effect of smoking cessation on the disease activity," said WSU Assistant Professor of Internal Medicine Marie-Claire Maroun, M.D., a rheumatologist and the project's principal investigator.
"The demonstration that the activity of the disease can improve through smoking cessation would mean less need for medications, less adverse effects and reduced cost, in addition to avoiding the devastating effects of smoking on health, such as emphysema and lung cancer," she added.
In the prospective study, RA patients who smoke will be randomized in two groups. One group will receive the usual care and routine smoking counseling from their rheumatologists. The second group will be referred for smoking cessation intervention at a clinic directed by WSU Associate Professor of Psychiatry and Behavioral Neurosciences David Ledgerwood, Ph.D.
Both groups will be followed clinically, and their disease activity will be closely monitored.
The results of the study are expected to improve current practices by showing that a smoking cessation strategy for patients is an important and essential part of their therapy. It may also give treating physicians a stronger argument for convincing patients that smoking cessation is a worthwhile goal.
"In addition, the reduction of the cost to treating rheumatoid arthritis and the health improvement achieved through smoking cessation will immensely benefit society," Dr. Maroun said.