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Passive smoking as a risk factor for developing rheumatoid arthritis

Dr. F. Javier Merayo Chalico

January 20, 2022

The pathogenesis of rheumatoid arthritis is a complex phenomenon involving the interaction of genetic and environmental
[1]
factors. A factor strongly implicated in autoimmunogenesis is lung inflammation caused by smoking . Although active smoking
is established as a risk factor for developing rheumatoid arthritis, the association between passive smoking and the
[two]
development of the disease has not been clarified.

A group of North American researchers published an analysis of a cohort with the aim of describing the role of passive smoking
[3]
in the development of rheumatoid arthritis.

The authors of this article analyzed data from the 116,000 registered nurses in the Nurses' Health Study II NHSII, who had been
followed up since 1989 through mailed questionnaires, with a mean of 27.7 years. Patients without an initial diagnosis of
rheumatoid arthritis with available information on passive smoking were included.

Passive tobacco exposure was classified as in utero exposure from maternal smoking , childhood exposure from parental
smoking, and passive exposure during adult life. The primary outcome was the diagnosis of rheumatoid arthritis based on
classification criteria. To distinguish whether passive smoking is a proinflammatory and pathogenic factor in rheumatoid arthritis
or whether it only increases the risk of later active smoking, active and passive smokers were compared against those who only
had passive exposure.

To perform the analysis, different variables that could be confounding were also considered, such as parental education and
occupation, family history of rheumatoid arthritis, maternal smoking during lactation, etc.

In total, 90,923 participants with 532 incident cases of rheumatoid arthritis were analyzed, of which 352 were seropositive.
Patients with passive exposure reported a higher prevalence of active smoking (38%) compared to those who did not indicate a
history of passive smoking (26%).

Patients who reported passive smoking were found to have a slightly increased risk of developing rheumatoid arthritis, with a
hazard ratio (HR) of 1.25 (95% confidence interval [95% CI]: 1.03 to 1 .52); in those with exposure in utero , a hazard ratio of
1.18 (95% CI: 0.96 to 1.46) was found in those with exposure during childhood.

However, these effects tended to disappear when the patient's active smoking status was taken into account. The authors also
performed subgroup analyzes according to the seropositivity status of the patients. This analysis showed that patients have a
higher risk of developing seropositive rheumatoid arthritis when there is passive exposure to tobacco in childhood (HR: 1.41;
95% CI: 1.08 to 1.83).

Based on this result, the authors concluded that smoking must play a proinflammatory role that contributes to the development
of autoimmunity; however, it is possible that this is a spurious statistical finding, caused by performing multiple analyzes by
subgroups without having the relevant methodological considerations. An analysis showing a correlation of the risk of
developing rheumatoid arthritis and the total exposure time could be more conclusive, however, the authors do not report this
type of analysis, probably due to data limitations.

This article constitutes the first analysis of a prospective cohort examining the risk of developing rheumatoid arthritis, with
extensive information on covariates and confounding variables. The authors concluded that the article demonstrates that
passive exposure to tobacco predisposes to developing rheumatoid arthritis, however, even if this finding is real and not just a
statistical anomaly, the effect size appears to be minimal.

Indeed, this study demonstrates that passive smoking is a risk factor for active smoking and thus increases the risk of
developing rheumatoid arthritis.

clinical point

Although the effect of passive smoking appears to be small or null for the development of rheumatoid arthritis, this article allows
us to highlight a previously known fact that can be applied in daily practice: active smoking is one of the most important factors
in the development of rheumatoid arthritis. rheumatoid arthritis. Regardless of previous or current exposure to secondhand
smoke, the best thing a patient at risk of developing rheumatoid arthritis can do is to refrain from smoking.
Follow Dr. Javier Merayo Chalico of Medscape in Spanish on Twitter @merayo_dr .

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References

1. Demoruelle MK, WilsonTM, Deane KD. Lung inflammation in the pathogenesis of rheumatoid arthritis. Immunol Rev Mar
2020;294(1):124-132. doi: 10.1111/imr.12842. PMID: 32030763. Source

2. Chang K, Yang SM, Kim SH, Han KH, et al. Smoking and Rheumatoid Arthritis. Int J Mol Sci. 2014 Dec 3;15(12):22279-
95. doi: 10.3390/ijms151222279. PMID: 25479074. Source

3. Yoshida K, Wang J, Malspeis S, Marchand N, et al. Passive Smoking Throughout the Life Course and the Risk of
Incident Rheumatoid Arthritis in Adulthood Among Women. Arthritis Rheumatol. 2021 Dec;73(12):2219-2228. doi:
10.1002/art.41939. PMID: 34406709. Source

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Cite this: Passive Smoking Risk Factor for Rheumatoid Arthritis - Medscape - Jan 20, 2022.