Rheumatoid: You must stop smoking!

By Dr Irwin Lim, Rheumatologist

I was discussing rheumatoid arthritis management with a bunch of colleagues, and we were discussing various peculiarities and relative properties of the biologic medications.

At some stage, one rheumatologist mentioned that she finds herself spending more and more time addressing smoking cessation.

Patients with Rheumatoid Arthritis die from heart attacks and vascular complications.

This is well known, and the good news is that better disease control reduces the risk of this. In addition, TNF inhibitor therapy reduces this risk of dying from cardiovascular causes more than the traditional DMARDs.

But we can do more. Weight loss and improved nutrition, increased exercise to improve fitness, treating blood pressure, et cetera.

Often, the hardest nut to crack is SMOKING.

Smoking is not good for Rheumatoid because:

• It acts as a trigger leading to the disease
• It leads to more active disease
• It reduces the effectiveness of Methotrexate
• It reduces the effectiveness of TNF-inhibitor therapy

And by the way, if you didn't already know, smoking does cause lung damage, increases risk of cancer, and greatly increases the risk of strokes and heart attacks.

I remarked to this very caring and competent rheumatologist that I wasn't very good at getting my patients to stop smoking.

If you're a smoker, what can I say to you to make you stop? Because, you really do need to.