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Smoking intensity, duration, and cessation, and the risk of rheumatoid arthritis in women.
Am J Med. 2006 Jun; 119(6):503.e1-9.AJ

Abstract

BACKGROUND

Cigarette smoking has been associated with rheumatoid arthritis (RA), but the importance of smoking intensity, duration, and time since quitting, and whether the risk is primarily for rheumatoid factor (RF) seropositive versus seronegative RA are still unclear.

METHODS

We conducted a prospective analysis of smoking and the risk of RA among 103,818 women in the Nurses' Health Study. A total of 680 RA cases, diagnosed from 1976 and 2002, were confirmed using a questionnaire and medical record review. Sixty percent were RF positive. Cox proportional hazards models calculated the relative risks (RRs) of RA with smoking, adjusting for reproductive and lifestyle factors.

RESULTS

The RR of RA was significantly elevated among current (RR 1.43 [95% confidence interval 1.16-1.75]) and past smokers (RR 1.47 [95% confidence interval 1.23-1.76]), compared with never smokers. The risk of RA was significantly elevated with 10 pack-years or more of smoking and increased linearly with increasing pack-years (P trend <.01). A greater number of daily cigarettes and longer duration of smoking were associated with increased risk. The effect of smoking was much stronger among RF-positive cases than among RF-negative cases. The risk remained elevated in past smokers until 20 years or more after cessation.

CONCLUSIONS

In this large cohort, past and current cigarette smoking were related to the development of RA, in particular seropositive RA. Both smoking intensity and duration were directly related to risk, with prolonged increased risk after cessation.

Authors+Show Affiliations

Costenbader KH
Division of Rheumatology, Immunology, and Allergy, Robert B. Brigham Arthritis and Musculoskeletal Diseases Clinical Research Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass 02115, USA. KCostenbader@partners.org
Feskanich D
No affiliation info available
Mandl LA
No affiliation info available
Karlson EW
No affiliation info available

MeSH

AdultAgedAged, 80 and overArthritis, RheumatoidBiomarkersConfounding Factors, EpidemiologicFemaleFollow-Up StudiesHumansMiddle AgedMultivariate AnalysisNursesProportional Hazards ModelsProspective StudiesRheumatoid FactorRisk AssessmentRisk FactorsSmokingSmoking CessationSurveys and QuestionnairesTime FactorsUnited States

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

16750964

Citation

Costenbader, Karen H., et al. "Smoking Intensity, Duration, and Cessation, and the Risk of Rheumatoid Arthritis in Women." The American Journal of Medicine, vol. 119, no. 6, 2006, pp. 503.e1-9.
Costenbader KH, Feskanich D, Mandl LA, et al. Smoking intensity, duration, and cessation, and the risk of rheumatoid arthritis in women. Am J Med. 2006;119(6):503.e1-9.
Costenbader, K. H., Feskanich, D., Mandl, L. A., & Karlson, E. W. (2006). Smoking intensity, duration, and cessation, and the risk of rheumatoid arthritis in women. The American Journal of Medicine, 119(6), e1-9.
Costenbader KH, et al. Smoking Intensity, Duration, and Cessation, and the Risk of Rheumatoid Arthritis in Women. Am J Med. 2006;119(6):503.e1-9. PubMed PMID: 16750964.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Smoking intensity, duration, and cessation, and the risk of rheumatoid arthritis in women. AU - Costenbader,Karen H, AU - Feskanich,Diane, AU - Mandl,Lisa A, AU - Karlson,Elizabeth W, PY - 2005/05/16/received PY - 2005/09/21/accepted PY - 2006/6/6/pubmed PY - 2006/6/10/medline PY - 2006/6/6/entrez SP - 503.e1 EP - 9 JF - The American journal of medicine JO - Am J Med VL - 119 IS - 6 N2 - BACKGROUND: Cigarette smoking has been associated with rheumatoid arthritis (RA), but the importance of smoking intensity, duration, and time since quitting, and whether the risk is primarily for rheumatoid factor (RF) seropositive versus seronegative RA are still unclear. METHODS: We conducted a prospective analysis of smoking and the risk of RA among 103,818 women in the Nurses' Health Study. A total of 680 RA cases, diagnosed from 1976 and 2002, were confirmed using a questionnaire and medical record review. Sixty percent were RF positive. Cox proportional hazards models calculated the relative risks (RRs) of RA with smoking, adjusting for reproductive and lifestyle factors. RESULTS: The RR of RA was significantly elevated among current (RR 1.43 [95% confidence interval 1.16-1.75]) and past smokers (RR 1.47 [95% confidence interval 1.23-1.76]), compared with never smokers. The risk of RA was significantly elevated with 10 pack-years or more of smoking and increased linearly with increasing pack-years (P trend <.01). A greater number of daily cigarettes and longer duration of smoking were associated with increased risk. The effect of smoking was much stronger among RF-positive cases than among RF-negative cases. The risk remained elevated in past smokers until 20 years or more after cessation. CONCLUSIONS: In this large cohort, past and current cigarette smoking were related to the development of RA, in particular seropositive RA. Both smoking intensity and duration were directly related to risk, with prolonged increased risk after cessation. SN - 1555-7162 UR - https://www.unboundmedicine.com/medline/citation/16750964/Smoking_intensity_duration_and_cessation_and_the_risk_of_rheumatoid_arthritis_in_women_ DB - PRIME DP - Unbound Medicine ER -