Smoking cessation for reducing disease activity in chronic a | Figure 1

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Smoking cessation for reducing disease activity in chronic autoimmune inflammatory joint diseases

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Are smoking cessation interventions effective for quitting smoking and reducing disease activity in people with chronic inflammatory joint disease?

Background

Tobacco smoking increases the risk of developing inflammatory joint diseases (IJDs) such as rheumatoid arthritis, where the joints are progressively damaged by the body's own immune system. Smoking may also worsen symptoms of these diseases. This review looked at whether supportive programmes to help smokers with IJDs quit smoking actually lead to quitting and reduced inflammation in the joints and elsewhere. Inflammation from these diseases can lead to heart attack and stroke, for which people with IJD are at higher risk.

Study characteristics

We searched the literature in October 2018. We included two studies with a total of 57 adult smokers ‐ both men and women ‐ with rheumatoid arthritis. One of the studies tested an intervention to help people with rheumatoid arthritis to quit smoking. This study recruited only smokers and compared this specialist, stop smoking programme with a standard, less intensive stop smoking programme. The other study tested an intervention to reduce the risk of heart disease and stroke in people with rheumatoid arthritis. Researchers recruited non‐smokers and smokers and compared this programme to a brief factual information leaflet about risks of heart disease. Both studies followed study participants for six months.

These studies were funded by Arthritis Research UK Educational Research Fellowship, Arthritis Research UK, the New Zealand Health Research Council, Arthritis New Zealand, and the University of Otago Research Fund.

Key results

Neither of the two included studies found that the more intensive, specialist interventions aimed at people with rheumatoid arthritis helped more people with rheumatoid arthritis to quit smoking than the less intensive, generic interventions. Only one of the studies reported on the safety of the stop smoking programme used. Very few side effects related to use of nicotine replacement therapy were reported, and none of these were serious. As a result, we do not know whether helping people with inflammatory arthritis improves their disease.

Quality of the evidence

We rated the overall quality of the included studies as very low because studies were very few and included few participants; only one of the studies tested an intervention that specifically tried to help people to quit smoking, and there is a chance that people who received the intensive intervention were more likely to incorrectly report that they had stopped smoking when in fact they had not. As a result, further large studies should be carried out to test stop smoking programmes for people with IJD. Researchers should ensure that they measure whether people's IJD symptoms improve, and should confirm whether people have stopped smoking.

Read the full Cochrane Review here

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