Efficacy of a smoking cessation program in patients with rheumatoid arthritis

Background. Smoking is a significant risk factor for the development of chronic non-infectious diseases such as malignant tumors, cardiovascular and respiratory diseases. Smoking is also considered one of the most important external risk factors for the development and severity of rheumatoid arthritis. It is associated with rapid disease progression, worsening of rheumatoid arthritis, and decreased treatment effectiveness. It is known that smoking in rheumatoid arthritis s associated with an increased risk of cardiovascular diseases and cardiovascular mortality. It is necessary to develop effective methods of quitting smoking among patients with rheumatoid arthritis. Objective. to develop a smoking cessation program for rheumatoid arthritis and evaluate the impact of this program on the patient's decision to stop smoking.

Materials and methods. The prospective cohort included smoking patients with rheumatoid arthritis in inpatient treatment. The smoking cessation program included individual preventive counseling and a Smoking Cessation School. The duration of follow-up after the intervention was 12 months.

Results. 194 smoking patients with rheumatoid arthritis were included: 123 women and 71 men, with an average age of 58.3 ± 10.2 years. The group consisted of smokers with long experience (average experience of 32.0 ± 12.1 years) and high smoking intensity (average smoking index 22.1 ± 14.6 pack/years). 71% have made repeated unsuccessful attempts to quit smoking. All patients received individual preventive counseling. 38 people visited the Smoking Cessation School. After 12 months, 22 people (11.8%) quit smoking, more often after attending School. Among those who quit smoking, there were fewer patients with high nicotine dependence (p = 0.005) and there were more previous attempts at quitting (p = 0.01). They were more likely to have comorbidity, mainly cardiovascular diseases (p = 0.02), and chronic kidney disease (p = 0.003). The characteristics of rheumatoid arthritis (duration of the disease, disease activity, radiographic progression, extra-articular manifestations), including the intensity of pain, did not affect the patient's decision to quit smoking.

Conclusion. The smoking cessation program in patients with rheumatoid arthritis is effective and should become part of clinical practice.

1. WHO Report on the Global Tobacco Epidemic, 2021: Addressing New and Emerging Products. Geneva: World Health Organization, 2021. 210 p. (In Russ.)

2. Andreeva E. A., et al. Prevalence of chronic obstructive pulmonary disease and its risk factors among residents of Saint Petersburg and Arkhangelsk (based on the RESPECT project). Russian Family Doctor. 2023; 4 (26): 17-24.

3. Starodubov V. I., et al. The burden of disease in Russia from 1980 to 2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet. 2018; 10153 (392): 1138-1146.

4. Gwinnutt J. M., Verstappen S. M., Humphreys J. H. The impact of lifestyle behaviours, physical activity and smoking on morbidity and mortality in patients with rheumatoid arthritis, Best Practice & Research. Clinical Rheumatology. 2020; 2 (34): 101562.

5. McWilliams D. F., et al. Discrete Trajectories of Resolving and Persistent Pain in People With Rheumatoid Arthritis Despite Undergoing Treatment for Inflammation: Results From Three UK Cohorts. The Journal of Pain. 2019; 6 (20): 716-727.

6. Safy-Khan M., et al. Current Smoking Negatively Affects the Response to Methotrexate in Rheumatoid Arthritis in a Dose-responsive Way, Independently of Concomitant Prednisone Use. The Journal of Rheumatology. 2021; 10 (48): 1504-1507.

7. Jansen G., De Rotte M. C. F. J. De Jonge R. Smoking and Methotrexate Inefficacy in Rheumatoid Arthritis: What About Underlying Molecular Mechanisms? The Journal of Rheumatology. 2021; 10 (48): 1495-1497.

8. Crowson C. S., et al. Impact of risk factors associated with cardiovascular outcomes in patients with rheumatoid arthritis. Annals of the Rheumatic Diseases. 2018; 1 (77): 48-54.

9. Roelsgaard I. K. и др. Smoking cessation is associated with lower disease activity and predicts cardiovascular risk reduction in rheumatoid arthritis patients. Rheumatology (Oxford, England). 2020; 8 (59): 1997-2004.

10. Tobacco dependence syndrome, tobacco withdrawal syndrome in adults: F17.2, F17.3 clinical guidelines. Ministry of Health of the Russian Federation, Russian Respiratory Society, Association of Narcologists. Moscow, 2018. 53 p. (In Russ.)

11. Sales M. P. U. и др. The impact of smoking cessation on patient quality of life. Jornal Brasileiro de Pneumologia. 2009; 5 (35): 436-441.

12. Naranjo A., et al. Results of a specific smoking cessation program for patients with arthritis in a rheumatology clinic. Rheumatology International. 2014; 1 (34): 93-99.

13. Matcham F., et al. The impact of rheumatoid arthritis on quality-of-life assessed using the SF-36: A systematic review and meta-analysis. Seminars in Arthritis and Rheumatism. 2014; 2 (44): 123-130.

14. Tański W., et al. Sexual Dysfunction and Quality of Life in Patients with Rheumatoid Arthritis. International Journal of Environmental Research and Public Health. 2022; 5 (19): 3088.

15. Nebhinani N., Mattoo S. K., Wanchu A. Quality of Life, Social Support, Coping Strategies, and Psychiatric Morbidity in Patients with Rheumatoid Arthritis. Journal of Neurosciences in Rural Practice. 2022; (13): 119-122.

16. Naidenova N. E. Experience in providing and evaluating the effectiveness of counseling services for smoking cessation in primary health care. Prevention 2015, Moscow, June 11, 2015. Russian Cardiological Society. Moscow: Silicea-Poligraf LLC, 2015. Pp. 13b-14a. EDN UATNUR. (In Russ.)

17. Karlsson M.-L., et al. Evaluation of an individually tailored smoking-cessation intervention for patients with rheumatoid arthritis in an outpatient clinic. Scandinavian Journal of Rheumatology. 2023. P. 1-11.

18. Lopez-Olivo M. A., et al. A systematic review with meta-analysis of the effects of smoking cessation strategies in patients with rheumatoid arthritis. PLOS ONE. 2022; 12 (17): e0279065.

19. Lopez-Olivo M. A., et al. Smoking cessation patterns, usefulness of quitting methods, and tobacco cessation motivators and barriers to quit in patients with rheumatoid arthritis. Clinical Rheumatology. 2023; 8 (42): 2053-2068.

20. Rheumatoid arthritis: ICD 10: M05, M06 clinical guidelines. Ministry of Health of the Russian Federation, Association of Rheumatologists of Russia, Russian Rheumatology Association "Nadezhda" LLC. Moscow, 2023. 112 p. Text: electronic. Rubricator of clinical guidelines of the Ministry of Health of the Russian Federation: [website]. URL: https://cr.minzdrav.gov.ru/schema/250_2 (accessed: 10.10.2024). (In Russ.)

21. Federal Law No. 15-FZ of February 23, 2013, "On the Protection of Citizens' Health from the Effects of Environmental Tobacco Smoke and the Consequences of Tobacco Consumption". B. m.: Specialized legal website ConsultantPlus. www.consultant.ru. (In Russ.)