Evaluation of an individually tailored smoking-cessation intervention for patients with rheumatoid arthritis in an outpatient clinic

OBJECTIVE

The aim of this study was to evaluate an individually tailored smoking-cessation intervention delivered in rheumatology care and compare the characteristics of patients who quit smoking with those who did not.

METHOD

This was an open single-group prospective intervention study over 24 months, with assessments at baseline and at 6, 12, 18, and 24 months. Current smokers with rheumatoid arthritis (RA) were invited to a smoking-cessation programme including behavioural change support, with or without pharmacotherapy. Data on disease activity, medical treatment, and patient-reported outcomes were retrieved from the Swedish Rheumatology Quality Register. The primary outcome was the proportion of patients at month 24 who reported having quit smoking with self-reported 7 day smoking abstinence.

RESULTS

In total, 99 patients participated in the study. Median age was 58 years (interquartile range 50-64); 69% were female and 88% rheumatoid factor and/or anti-cyclic citrullinated peptide positive. At 24 months, 21% of the patients had quit smoking. At 6, 12, and 18 months, 12%, 12%, and 14% of patients, respectively, had quit smoking. For patients still smoking at 24 months, the median number of cigarettes per day was significantly reduced from 12 to 6 (p ≤ 0.001). Among patients who had quit smoking at 24 months, a smaller proportion reported anxiety at baseline compared to those still smoking (28% vs 58%, p = 0.02).

CONCLUSION

A smoking-cessation intervention including behavioural change support with or without pharmacotherapy can be helpful for a substantial number of RA patients. Anxiety is associated with lower smoking-cessation success rates.

Mismatch negativity to change in spatial location of an auditory stimulus

Auditory stimulus blocks were presented to 12 reading subjects. Each block consisted of 2 types, standard (P = 90%) and deviant stimuli (P = 10%), delivered in a random order. The only difference between these stimuli was their spatial location of origin. The subject always heard the standards as coming straight in front and the deviants from an angle of either 10, 45, or 90 degrees to the right of the standards. The spatial locations were produced via earphones by introducing for low-frequency (600 Hz) tones an interaural phase difference and for high-frequency (3000 Hz) tones an interaural intensity difference. Standard and deviant stimuli were also delivered in more natural, free-field, conditions via differently positioned loudspeakers. The deviant tones elicited an event-related brain potential component called the mismatch negativity (MMN), followed by a P3a component. Thus changes in spatial location of an auditory stimulus produced by following either one of the two main principles of human sound localization elicited the MMN. Consequently, it was concluded that the spatial location of a sound source is coded in the hypothesized neuronal stimulus traces reflected by the MMN and, further, that a change in this location is automatically detected by the brain by means of the MMN generator process.