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. 2019 Apr;46(4):370-375.
doi: 10.3899/jrheum.180262. Epub 2018 Dec 1.

Smoking Is Associated with Higher Disease Activity in Rheumatoid Arthritis: A Longitudinal Study Controlling for Time-varying Covariates

Milena A Gianfrancesco  1   2 , Laura Trupin  3   4 , Stephen Shiboski  3   4 , Mark van der Laan  3   4 , Jonathan Graf  3   4 , John Imboden  3   4 , Jinoos Yazdany  3   4 , Gabriela Schmajuk  3   4
Affiliations

Smoking Is Associated with Higher Disease Activity in Rheumatoid Arthritis: A Longitudinal Study Controlling for Time-varying Covariates

Milena A Gianfrancesco et al. J Rheumatol. 2019 Apr.

Abstract

Objective: Prior studies around the relationship between smoking and rheumatoid arthritis (RA) disease activity have reported inconsistent findings, which may be ascribed to heterogeneous study designs or biases in statistical analyses. We examined the association between smoking and RA outcomes using statistical methods that account for time-varying confounding and loss to followup.

Methods: We included 282 individuals with an RA diagnosis using electronic health record data collected at a public hospital between 2013 and 2017. Current smoking status and disease activity were assessed at each visit; covariates included sex, race/ethnicity, age, obesity, and medication use. We used longitudinal targeted maximum likelihood estimation to estimate the causal effect of smoking on disease activity measures at 27 months, and compared results to conventional longitudinal methods.

Results: Smoking was associated with an increase of 0.64 units in the patient global score compared to nonsmoking (p = 0.01), and with 2.58 more swollen joints (p < 0.001). While smoking was associated with a higher clinical disease activity score (2.11), the difference was not statistically significant (p = 0.22). We found no association between smoking and physician global score, or C-reactive protein levels, and an inverse association between smoking and tender joint count (p = 0.05). Analyses using conventional methods showed a null relationship for all outcomes.

Conclusion: Smoking is associated with higher levels of disease activity in RA. Causal methods may be useful for investigations of additional exposures on longitudinal outcome measures in rheumatologic disease.

Keywords: DISEASE ACTIVITY; EPIDEMIOLOGY; RHEUMATOID ARTHRITIS; SMOKING.

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References

    1. Yelin E, Meenan R, Nevitt M, Epstein W. Work disability in rheumatoid arthritis: effects of disease, social, and work factors. Ann Intern Med 1980;93:551–6. - PubMed
    1. Sugiyama D, Nishimura K, Tamaki K, Tsuji G, Nakazawa T,Morinobu A, et al. Impact of smoking as a risk factor for developing rheumatoid arthritis: a meta-analysis of observational studies. Ann Rheum Dis 2010;69:70–81. - PubMed
    1. Wolfe F The effect of smoking on clinical, laboratory, and radiographic status in rheumatoid arthritis. J Rheumatol 2000;27:630–7. - PubMed
    1. Mikuls TR, Hughes LB, Westfall AO, Holers VM, Parrish L, van der Heijde D, et al. Cigarette smoking, disease severity and autoantibody expression in African Americans with recent-onset rheumatoid arthritis. Ann Rheum Dis 2008;67:1529–34. - PMC - PubMed
    1. Mattey DL, Dawes PT, Fisher J, Brownfield A, Thomson W, Hajeer AH, et al. Nodular disease in rheumatoid arthritis: association with cigarette smoking and HLA-DRB1/TNF gene interaction. J Rheumatol 2002;29:2313–8. - PubMed

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