Does quitting smoking affect arthritis pain?

Quitting Smoking Significantly Reduces Arthritis Pain and Improves Disease Outcomes

People with rheumatic and musculoskeletal diseases (RMDs) should be strongly encouraged to stop smoking as it is detrimental to symptoms, function, disease activity, disease progression, and occurrence of comorbidities in all RMDs. 1

Impact of Smoking on Arthritis

Smoking has multiple negative effects on arthritis:

• Worsens disease activity and symptoms in rheumatoid arthritis (RA) and other RMDs 1
• Reduces response to disease-modifying anti-rheumatic drugs (DMARDs) in RA 1, 2
• Increases need for more aggressive medication combinations 2
• Results in poorer functional outcomes in ankylosing spondylitis 1
• Creates pro-inflammatory environment that exacerbates joint pain 3
• Decreases likelihood of achieving remission 4

Benefits of Smoking Cessation on Arthritis Pain

Quitting smoking provides several benefits for arthritis patients:

1. Improved Treatment Response

   • Enhances effectiveness of medications, particularly DMARDs 1, 2
   • Patients who quit smoking have better EULAR response rates compared to current smokers 4

2. Reduced Disease Activity

   • Former smokers have significantly lower disease activity scores than current smokers at 12-month follow-up 4
   • Higher remission rates in former smokers (42%) compared to current smokers (33%) 4

3. Better Functional Outcomes

   • Improved physical function after quitting smoking 1
   • Non-smokers and those with fewer pack-years have twice the probability of achieving ACR improvement compared to heavy smokers 2

4. Decreased Pain Levels

   • Smoking cessation reduces the pro-inflammatory triggers that contribute to arthritis pain 3

Smoking Cessation Approaches for Arthritis Patients

The pooled smoking cessation rate across interventions for RA patients is approximately 22% 5, suggesting that quitting is achievable but challenging. Effective approaches include:

1. Healthcare Provider Involvement

   • Clinicians caring for people with RA serve an integral role in counseling on tobacco cessation 1
   • Provider training programs can increase referrals to quit services from 5% to 70% 5

2. Cessation Methods

   • Nicotine replacement therapy (perceived as useful by 31% of former smokers) 6
   • Individual counseling (27% found useful) 6
   • Group counseling (21% found useful) 6
   • "Cold turkey" approach (commonly used) 6

3. Addressing Barriers

   • Many current smokers report using smoking to manage negative emotions and as a coping mechanism for RA 6
   • Cessation programs should specifically address these emotional barriers 6

Important Considerations

• Timing: Benefits of quitting may not be immediate but increase over time
• Motivation: Experiencing a major health event is the most common motivator for quitting among RA patients 6
• Comprehensive Approach: Smoking cessation should be part of overall patient care alongside medication management 1
• Monitoring: Patients who quit smoking should continue to be monitored for disease activity, as improvements may take time to manifest

Conclusion

The evidence strongly supports that quitting smoking has significant positive effects on arthritis pain and disease outcomes. While smoking does not appear to directly affect radiographic progression in RA patients 2, it negatively impacts disease activity, treatment response, and functional status. Healthcare providers should prioritize smoking cessation counseling as an essential component of arthritis management.