Abstract
The purpose of this study is to determine factors associated with a non-ACR 50 response at 6 months of follow-up, in a cohort of patients with early rheumatoid arthritis (RA). Early RA patients (symptom duration <1 year), treated with the same combination treatment (methotrexate and sulfasalazine), were included. Demographic characteristics of the patients including current smoker status (defined as a patient that smokes at least one cigarette per day), years of formal education, a 28-joint count for swelling and tenderness were registered. A basal HAQ questionnaire, visual scales for global assessment, and pain were answered by all patients, and a CDAI basal score was calculated. The ACR 50 response was determined at 6 months follow-up. Multivariable logistic regression analysis was used to calculate adjusted ORs. Two hundred twenty-five patients were evaluated, but only 144 had a complete follow-up, 43% of the latter did not reach an ACR 50 response. The only factor associated with this outcome was current smoking (OR 3.58, P < 0.008, 95% CI 1.23–11.22). Low level of formal education (≤6 years) had a tendency towards a statistical difference (P < 0.08). After controlling with low level of formal education, sex, age in years, and CDAI baseline value with multivariable logistic regression analysis, current smoking status had an adjusted OR of 3.91 (P < 0.009, 95% CI 1.41–10.81). Smoking is associated with a non-ACR 50 response in early rheumatoid arthritis in patients treated with a combination therapy with methotrexate and sulfasalazine.
Similar content being viewed by others
References
Gordon DA, Hastings DE (2003) Clinical features of rheumatoid arthritis. In: Hochberg MC, Silman AJ, Smolen JS, Weinblat ME, Weisman MH (eds) Rheumatology, 3rd edn. Mosby, Edinburgh, pp 765–780
Van der Heijde D, van Riel PL, Nuver-Zwart HH, Gribnau FW, van de Putte LBA (1989) Effects of hydroxychloroquine and sulphasalazine on progression of joint damage in rheumatoid arthritis. Lancet 1:1036–1038
Egsmose C, Lund B, Borg G, Pettersson H, Berg E, Brodin U, Trang L (1995) Patients with rheumatoid arthritis benefit from early 2nd line therapy: 5-year followup of a prospective double blind placebo controlled study. J Rheumatol 22:2208–2213
Abu-Shakra M, Toker R, Flusser D, Flusser G, Friger M, Sukenik S, Buskila D (1998) Clinical and radiographic outcomes of rheumatoid arthritis patients not treated with disease-modifying drugs. Arthritis Rheum 41:1190–1195
Choi HK, Hernán MA, Seeger JD, Robins JM, Wolfe F (2002) Methotrexate and mortality in patients with rheumatoid arthritis: a prospective study. Lancet 359:1173–1177
Krause D, Schleusser B, Herborn G, Rau R (2000) Response to methotrexate treatment is associated with reduced mortality in patients with severe rheumatoid arthritis. Arthritis Rheum 43:14–21
Möttönen T, Hannonen P, Leirisalo-Repo M et al (1999) Comparison of combination therapy with single-drug therapy in early rheumatoid arthritis: a randomized trial. Lancet 353:1568–1573
Grigor C, Appel H, Stirling A et al (2004) Effect of a treatment strategy of tight control for rheumatoid arthritis (the TICORA study): a single-blind randomized controlled trial. Lancet 364:263–269
Rojas-Serrano J, Burgos-Vargas R, Lino-Pérez L (2010) El tabaquismo se asocia a una falla para alcanzar una respuesta ACR 50. Estudio de cohorte de pacientes con artritis reumatoide de inicio reciente. Reumatol Clin 6:s39–s40
Gossec L, Dougados M, Goupille P et al (2004) Prognostic factors for remission in early rheumatoid arthritis: a multiparameter prospective study. Ann Rheum Dis 63:675–680
Hider SL, Buckley C, Silman AJ, Symmons DPM, Bruce IN (2005) Factors influencing response to disease modifying antirheumatic drugs in patients with rheumatoid arthritis. J Rheumatol 32:11–16
Anderson JJ, Wells G, Verhoven AC, Felson DT (2000) Factors predicting response to treatment in rheumatoid arthritis: the importance of disease duration. Arthritis Rheum 43:22–29
Ranganathan P, McLeod HL (2006) Methotrexate pharmacogenetics. The first step toward individualized therapy in rheumatoid arthritis. Arthritis Rheum 54:1366–1377
Lee YC, Cui J, Costenbader KH et al (2009) Investigation of candidate polymorphisms and disease activity in rheumatoid arthritis patients on methotrexate. Rheumatology 48:613–617
Derviux T (2009) Methotrexate pharmacogenomics in rheumatoid arthritis: introducing false-positive report probability (editorial). Rheumatology 48:1619–1620
Arnett FC, Edworthy SM, Bloch DA et al (1988) The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 31:315–324
Cardiel MH, Abello-Banfi M, Ruiz-Mercado R, Alarcón-Segovia D (1993) How to measure health status in rheumatoid arthritis in non-English speaking patients: validation of a Spanish version of the Health Assessment Questionnaire Disability Index (Spanish HAQ-DI). Clin Exp Rheumatol 11:117–121
Smolen JS, Breedveld FC, Schiff MH et al (2003) A simplified disease activity index for rheumatoid arthritis for use in clinical practice. Rheumatology 42:244–257
Felson DT, Anderson JJ, Boers M et al (1995) American College of Rheumatology preliminary definition of improvement in rheumatoid arthritis. Arthritis Rheum 38:727–735
Vessey MP, Villard-MAckintosh L, Yeates D (1987) Oral contraceptives, cigarette smoking and other factors in relation to arthritis. Contraception 35:457–464
Silman AJ, Newman J, Mac Gregor AJ (1996) Cigarette smoking increases the risk of rheumatoid arthritis. Results from a nationwide study of disease-discordant twins. Arthritis Rheum 39:732–735
Symmons DP, Bankhead CR, Harrison BJ et al (1997) Blood transfusion, smoking, and obesity as risk factors for the development of rheumatoid arthritis: results from a primary care-based incident case-control study in Norfolk, England. Arthritis Rheum 40:1955–1961
Karlson EW, Lee IM, Cook NR, Manson JE, Buring JE, Hennekens CH (1999) A retrospective cohort study of cigarette smoking and risk of rheumatoid arthritis in female health professionals. Arthritis Rheum 42:910–917
Padyukov L, Silva C, Stolt P, Alfredsson L, Klareskog L (2004) A gene–environment interaction between smoking and shared epitope genes in HLA-DR provides a high risk of seropositive rheumatoid arthritis. Arthritis Rheum 50:3085–3092
Klareskog L, Stolt P, Lundberg K et al (2006) A new model for an etiology of rheumatoid arthritis. Smoking may trigger HLA-DR (shared epitope)-restricted immune reactions to autoantigens modified by citrullination. Arthritis Rheum 54:38–46
Wessels JAM, van der Kooij SM, le Cessie S et al (2007) A clinical pharmacogenetic model to predict the efficacy of methotrexate monotherapy in recent onset rheumatoid arthritis. Arthritis Rheum 56:1765–1775
Saevarsdottir S, Wedrén S, Seddighzadeh M et al (2009) Smoking is associated with non response to methotrexate and to anti-TNF treatment in patients with rheumatoid arthritis. Results from Swedish EIRA study (abstract). Arthritis Rheum 60:S237–S238
Disclosures
None.
Author information
Authors and Affiliations
Corresponding author
Additional information
This work was supported by grants of the CONACyT, SALUD-2007-01-71161, a Mexican agency supporting science.
Rights and permissions
About this article
Cite this article
Rojas-Serrano, J., Pérez, L.L., García, C.G. et al. Current smoking status is associated to a non-ACR 50 response in early rheumatoid arthritis. A cohort study. Clin Rheumatol 30, 1589–1593 (2011). https://doi.org/10.1007/s10067-011-1775-5
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10067-011-1775-5