Fathi Hanan M, Tharwat Samar, El Hadidi Khaled, Abdel-Fattah Yousra H, Amer Marwa A, Ibrahim Amira M, Elzokm Saad M, El-Saadany Hanan M, Elwan Shereen, Mosad Doaa, Nasef Samah Ismail, Ibrahim Maha E, Elsehrawy Gehad G, Al-Adle Suzan S, Samy Nermeen, Mohamed Eman F, Abdelaleem Enas A, Taha Hanan, Ismail Faten, Selim Zahraa I, Gamal Nada M, Elsaman Ahmed, Hammam Osman, Mohammed Reem H, Hammam Nevin, Gheita Tamer A
Rheumatology Department, Faculty of Medicine, Fayoum University, Fayoum, Egypt.
Internal Medicine Department, Rheumatology Unit, Faculty of Medicine, Mansoura University, Dakahlia, Egypt.
Saudi J Med Med Sci. 2025 Apr-Jun;13(2):90-98. doi: 10.4103/sjmms.sjmms_746_24. Epub 2025 Apr 21.
Smoking may increase levels of pro-inflammatory cytokines, which is an important contributor to rheumatoid arthritis (RA) pathogenesis.
The aim of this study was to describe the characteristics of RA patients who were smokers compared with non-smokers.
A total of 849 RA patients who were smokers out of a large RA cohort of 10,364 patients (8.2%) were compared to 924 age-, sex-, and body mass index-matched RA patients who were non-smokers. Patients were subjected to full history-taking and clinical examination. Laboratory tests such as rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP) were measured. The disease activity score 28 (DAS28) and the health assessment questionnaire (HAQ) score were assessed.
The mean age among smokers was 46.4 ± 11.3 years, the male-female ratio was 3:1, and the mean disease duration was 6.4 ± 6.2 years. There was a significantly higher frequency of diabetes mellitus, hypertension, and metabolic syndrome in smokers compared to non-smokers (13.7%, 17.1%, and 9.2% vs. 8.4%, 12.9%, and 3.5%; < 0.0001, = 0.01, < 0.0001, respectively), while hypothyroidism was more common in non-smokers ( = 0.03). Rheumatoid nodules ( = 0.03), oral ulcers ( = 0.002), keratoconjunctivitis sicca ( = 0.043), and neurological manifestations ( = 0.002) were significantly more common in smokers, but the DAS28 was lower (4.2 ± 1.5 vs. 4.8 ± 2.5; < 0.0001). RA-related changes were significantly more common in female smokers than in males. On regression analysis, none of the differences found in the comparison between smokers and non-smokers remained significant.
Smoking in RA patients was found to be associated with a higher frequency of traditional comorbidities, rheumatoid nodules, oral ulcers, sicca complex, and neurological manifestations, but a lower disease activity. There is an obvious sex-driven pattern, with clinical alterations occurring more frequently in female smokers. Higher RF, anti-CCP, and double seropositivity are more observable in males and positive antinuclear antibody in females.
吸烟可能会增加促炎细胞因子水平，这是类风湿关节炎（RA）发病机制的一个重要促成因素。
本研究旨在描述吸烟的RA患者与不吸烟的RA患者的特征。
在一个10364例患者的大型RA队列中，共有849例吸烟的RA患者（8.2%）与924例年龄、性别和体重指数相匹配的不吸烟的RA患者进行比较。对患者进行全面的病史采集和临床检查。检测类风湿因子（RF）和抗环瓜氨酸肽（抗CCP）等实验室指标。评估疾病活动度评分28（DAS28）和健康评估问卷（HAQ）评分。
吸烟者的平均年龄为46.4±11.3岁，男女比例为3:1，平均病程为6.4±6.2年。与不吸烟者相比，吸烟者患糖尿病、高血压和代谢综合征的频率显著更高（分别为13.7%、17.1%和9.2%，而不吸烟者为8.4%、12.9%和3.5%；P<0.0001、P = 0.01、P<0.0001），而甲状腺功能减退在不吸烟者中更常见（P = 0.03）。类风湿结节（P = 0.03）、口腔溃疡（P = 0.002）、干燥性角结膜炎（P = 0.043）和神经表现（P = 0.002）在吸烟者中明显更常见，但DAS28较低（4.2±1.5 vs. 4.8±2.5；P<0.0001）。与RA相关的改变在女性吸烟者中比在男性吸烟者中更常见。回归分析显示，吸烟者与不吸烟者比较中发现的差异均无统计学意义。
发现RA患者吸烟与传统合并症、类风湿结节、口腔溃疡、干燥综合征和神经表现发生率较高相关，但疾病活动度较低。存在明显的性别驱动模式，临床改变在女性吸烟者中更频繁发生。男性中RF、抗CCP及双重血清学阳性更常见，女性中抗核抗体阳性更常见。
