Coffee consumption, RF, and the risk of RA

Passive Smoking is Responsible for Disease Activity in Female Patients With Rheumatoid Arthritis

Objectives

This study aims to evaluate the effects of passive smoking on disease activity in female patients with rheumatoid arthritis (RA).

Patients and methods

Among a total of 191 female patients with RA (mean age 59.1±12.5 years; range 21 to 87 years) consecutively recruited, 100 female patients (mean age 56.1±13.4 years; range 21 to 87 years) completed the study with mean 17.3 months of follow-up. Patients were classified according to smoking status: current, never, passive, or ex-smoker. Clinical response between never and passive smokers was assessed by disease- activity score 28 (DAS28)-erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) (DAS28-ESR and DAS28-CRP) and by the European League Against Rheumatism response criteria.

Results

Among the 100 female RA patients analyzed, the distribution of smoking status was as follows: current (n=3), never (n=55), passive (n=34), and ex-smokers (n=8). There was no difference of DAS28-ESR and DAS28-CRP between never and passive smokers at baseline. At the time of follow-up, the values of DAS28-ESR and DAS28-CRP in never smokers were significantly decreased than those in passive smokers (p=0.019 and p=0.023, respectively). Patients who never smoked showed a trend to have good or moderate European League Against Rheumatism response without statistical significance, compared to passive smokers (52.7% vs. 32.4%, respectively; p=0.060).

Conclusion

This preliminary study implicates that passive smoking might be responsible for higher disease activity in female RA patients and never smoking might induce good clinical response in RA.

Impact of secondhand smoking on disease activity in women with rheumatoid arthritis

Smoking is an established risk factor for the development and severity of rheumatoid arthritis (RA) with prominent production of cytokines. The aim of the work was to study the possible effect of secondhand exposure on disease activity in non-smoking female RA patients. This cross-sectional study include 100 women with RA attending the rheumatology outpatient clinic and were grouped according to the non-smoking status into those not exposed to smoking and those considered secondhand smokers (SHS). Disease activity score in 28 joints (DAS28) was calculated and the patients' global assessment (PGA) score were assessed. The mean age of the patients was 45.2 ± 12.1 years and disease duration was 8.3 ± 6 years. Their DAS28 score was 4.3 ± 0.93 with a PGA score of 1.47 ± 1.36. Forty-seven of the patients were SHS and 53 were non-exposed. The secondhand smokers were significantly younger (41.6 ± 11.7 years) than the non-smokers (48.3 ± 11.6 years) (p = 0.005), and the DAS28 was significantly higher (4.6 ± 0.84 versus 4.1 ± 0.97; p = 0.02) compared to non-smokers. The disease duration and medications received were comparable. There is evidence pointing to the important role of secondhand smoking on disease activity in RA female patients. Studying the effect of secondhand smoking in view of the cytokine milieu could help confirm the relation to the disease pathogenesis. Taking into consideration the risk of cardiovascular disease and interplay with other potential factors should be well thought of. It is essential to draw patients' attention to the expected hazardous effect of passive smoking.

Pathobiologic mechanisms of chronic obstructive pulmonary disease

COPD is a worldwide public health problem that reduces the quality of life. The exact pathways by which CS and other environmental toxins produce COPD are not known. Currently, the leading candidates are (1) the protease-antiprotease hypothesis, (2) the Dutch hypothesis, (3) the British hypothesis, and the (4) autoimmunity hypothesis. Given the heterogeneity of the disease (and phenotypes), it is probably unrealistic that one pathway will fully explain COPD pathophysiology.