Impact of secondhand smoking on disease activity in women with rheumatoid arthritis

Smoking is an established risk factor for the development and severity of rheumatoid arthritis (RA) with prominent production of cytokines. The aim of the work was to study the possible effect of secondhand exposure on disease activity in non-smoking female RA patients. This cross-sectional study include 100 women with RA attending the rheumatology outpatient clinic and were grouped according to the non-smoking status into those not exposed to smoking and those considered secondhand smokers (SHS). Disease activity score in 28 joints (DAS28) was calculated and the patients' global assessment (PGA) score were assessed. The mean age of the patients was 45.2 +/- 12.1 years and disease duration was 8.3 +/- 6 years. Their DAS28 score was 4.3 +/- 0.93 with a PGA score of 1.47 +/- 1.36. Forty-seven of the patients were SHS and 53 were non-exposed. The secondhand smokers were significantly younger (41.6 +/- 11.7 years) than the non-smokers (48.3 +/- 11.6 years) (p = 0.005), and the DAS28 was significantly higher (4.6 +/- 0.84 versus 4.1 +/- 0.97; p = 0.02) compared to non-smokers. The disease duration and medications received were comparable. There is evidence pointing to the important role of secondhand smoking on disease activity in RA female patients. Studying the effect of secondhand smoking in view of the cytokine milieu could help confirm the relation to the disease pathogenesis. Taking into consideration the risk of cardiovascular disease and interplay with other potential factors should be well thought of. It is essential to draw patients' attention to the expected hazardous effect of passive smoking.