Papadopoulos N G, Alamanos Y, Voulgari P V, Epagelis E K, Tsifetaki N, Drosos A A
Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece.
Clin Exp Rheumatol. 2005 Nov-Dec;23(6):861-6.
To investigate the association of cigarette smoking with clinical expression, disease activity and severity in a cohort of Greek patients with early rheumatoid arthritis (RA).
From January 1993 until December 2002, 293 patients with early RA were diagnosed and followed up in our rheumatology clinic. All patients fulfilled the American College of Rheumatology criteria for RA, had disease duration of less than one year, without prior treatment of disease modifying anti-rheumatic drugs (DMARDs) or steroids. The patients were treated with at least one DMARD, and 287 of them had a last follow up during the year 2004. The demographic, personal, clinical, laboratory, radiological and therapeutic features were compared at entry and at the last follow-up, according to their smoking habits at entry.
Among the 293 patients, 6 were lost to follow-up, thus 287 patients were evaluated. There were 200 females (67.7%) and 87 males (30.3%). Eighty-two (28.6%) were current smokers, 21 (7.3%) ex-smokers and 184 (64.1%) non-smokers at presentation. RA smoker patients displayed the disease at a younger age than the non-smokers. Additionally, the smokers presented at disease onset more prominent features of articular involvement as was evaluated by the higher number of total joint count with tenderness and swelling and by the higher disease activity for 28 joint indices score (DAS-28). Smokers also presented a higher Larsen's score and higher frequency of IgM and IgA rheumatoid factors as compared to non-smokers. At the end of the study, the smoker patients presented more active and severe disease as evaluated by the higher total number of tender and swelling joint count, the higher DAS-28, and higher Larsen's score as compared to non-smokers. Furthermore, the smokers more frequently had rheumatoid nodules than the ex-smokers and non-smokers. The association of smoking with disease activity and severity was independent of sex, age, educational level, alcohol consumption, and follow-up duration. Finally, no significant differences were observed concerning the therapeutic procedure among the three groups.
In our early RA patients, cigarette smoking was associated with increased disease activity, and severity, independently of several other possible confounders and despite the early disease treatment.
在一组希腊早期类风湿关节炎（RA）患者中，研究吸烟与临床表现、疾病活动度及严重程度之间的关联。
从1993年1月至2002年12月，293例早期RA患者在我们的风湿病诊所被诊断并接受随访。所有患者均符合美国风湿病学会的RA标准，病程少于1年，且未曾接受过改善病情抗风湿药物（DMARDs）或类固醇治疗。患者接受了至少一种DMARD治疗，其中287例在2004年进行了最后一次随访。根据患者入组时的吸烟习惯，对其人口统计学、个人、临床、实验室、放射学及治疗特征在入组时和最后一次随访时进行比较。
293例患者中，6例失访，因此对287例患者进行了评估。其中女性200例（67.7%），男性87例（30.3%）。入组时，82例（28.6%）为当前吸烟者，21例（7.3%）为既往吸烟者，184例（64.1%）为非吸烟者。RA吸烟者比非吸烟者发病年龄更小。此外，吸烟者在疾病发作时关节受累的特征更明显，这通过压痛和肿胀的关节总数更多以及28个关节指数评分（DAS-28）的疾病活动度更高来评估。与非吸烟者相比，吸烟者还表现出更高的 Larsen 评分以及更高频率的 IgM 和 IgA 类风湿因子。在研究结束时，与非吸烟者相比，吸烟者的疾病活动度和严重程度更高，这通过压痛和肿胀关节总数更多、DAS-28 更高以及 Larsen 评分更高来评估。此外，吸烟者比既往吸烟者和非吸烟者更频繁地出现类风湿结节。吸烟与疾病活动度和严重程度的关联独立于性别、年龄、教育水平、饮酒量及随访时间。最后，三组之间在治疗过程方面未观察到显著差异。
在我们的早期RA患者中，吸烟与疾病活动度增加及严重程度相关，独立于其他几个可能的混杂因素，且尽管进行了早期疾病治疗。
