Department of Rheumatology, Derby City General Hospital, Derby, United Kingdom.
J Clin Rheumatol. 2010 Jan;16(1):15-8. doi: 10.1097/RHU.0b013e3181ca4a2a.
To assess if smoking status at the time of commencing an anti-TNF-alpha agent for rheumatoid arthritis (RA) reduces the likelihood of achieving at least a moderate response on the European League Against Rheumatism (EULAR) response criteria at 3-month assessment.
All patients with RA treated with their first anti-TNF-alpha agent at the Department of Rheumatology, Derby Hospital NHS Trust between April 2001 and October 2008 were included in this retrospective case control study. Information about age, gender, disease duration, body mass index, smoking status (current smoker, ex-smoker, and nonsmoker), comorbidities, oral prednisolone use, and 28 joint 4 variables disease activity score (DAS28) at the time of commencing an anti-TNF-alpha agent was recorded. Details of rheumatoid factor (RF) and past and present disease modifying antirheumatic drugs were recorded. A case control study was carried out to examine possible baseline predictors of treatment effects at the 3-month assessment.
Results were available for 395 patients at 3-month assessment. According to the EULAR response criteria 42 patients failed to show at least a moderate response. After adjusting for confounders using multivariate analysis, current smoking at the time of commencing an anti-TNF-alpha agent reduced the chance of achieving at least a moderate response on the EULAR response criteria when compared with nonsmokers (aOR [95% CI] 0.20 [0.05-0.83], P = 0.03).
RA patients who smoke are less likely to respond to an anti-TNF-alpha agent.
评估类风湿关节炎（RA）患者在开始使用抗 TNF-α 药物时的吸烟状况是否会降低其在 3 个月评估时达到欧洲抗风湿病联盟（EULAR）缓解标准至少中度缓解的可能性。
本回顾性病例对照研究纳入了 2001 年 4 月至 2008 年 10 月期间德比医院 NHS 信托基金会风湿科首次使用抗 TNF-α 药物治疗的所有 RA 患者。记录了开始使用抗 TNF-α 药物时的年龄、性别、病程、体重指数、吸烟状况（当前吸烟者、曾经吸烟者和非吸烟者）、合并症、口服泼尼松龙的使用情况以及 28 关节 4 变量疾病活动评分（DAS28）。记录了类风湿因子（RF）和过去及目前的疾病修饰抗风湿药物的详细信息。进行病例对照研究以检查 3 个月评估时治疗效果的可能基线预测因素。
在 3 个月评估时，有 395 名患者的结果可用。根据 EULAR 缓解标准，有 42 名患者未达到至少中度缓解。使用多变量分析调整混杂因素后，与不吸烟者相比，开始使用抗 TNF-α 药物时的当前吸烟状况降低了达到 EULAR 缓解标准至少中度缓解的机会（优势比 [95%CI] 0.20 [0.05-0.83]，P=0.03）。
吸烟的 RA 患者对抗 TNF-α 药物的反应性较低。
