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RA, Smoking, and Alcohol

The potential risks smoking and drinking pose to people with rheumatoid arthritis.
By Stephanie Schupska
WebMD Feature

You already know that smoking is bad for you and that it's unhealthy to drink too much alcohol.

But do you know how tobacco and alcohol relate to rheumatoid arthritis -- your odds of developing RA, or, if you already have RA, your odds of making it worse?

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Here's what the research shows.

RA, Smoking, and Your Genes

Smoking may make people more likely to get RA. And, depending on their genes, it may make their RA worse. On top of that, smoking mixed with RA can lead to even greater problems, like heart disease.

"Very clear studies indicate that tobacco is highly associated [with] and probably causal in rheumatoid arthritis and is causal in the worst form of the disease," says Susan Goodman, MD, an assistant attending rheumatologist and internist at the Hospital for Special Surgery and assistant professor of medicine at Weill Cornell Medical College.

Your genes may also matter. A Swedish study, published in December 2010, shows that the odds of developing RA was related not just to how much a person smokes, but also to their genetic makeup. People with a certain gene variation, called HLA-DRB1, who smoke are much more likely to get rheumatoid arthritis than someone who doesn't smoke -- and to have severe RA.

"It turns out that people who smoke who bear this genetic factor are much more likely to develop rheumatoid arthritis and do develop more severe disease," Goodman says.

Health Problems From Smoking and RA

Smoking can also make dealing with the disease more difficult.

"In a lot of the studies on the course of rheumatoid arthritis, patients who smoke do less well, and they're less likely to achieve remission," Goodman says. "They're more likely to have a worse outcome. Smoking gives them a worse prognosis."

Smoking can increase painful rheumatoid nodules, which form in the joints, she says. It can also lead to heart disease, which -- even on its own -- is a big problem in people with RA. And smoking makes it worse.

"In the last 10 years, there have been studies that show the leading cause of death in patients with RA is cardiovascular disease," says Walter Moore, MD, senior associate dean for graduate medical education and veteran affairs at Georgia Health Sciences University and chief of rheumatology at Charlie Norwood Department of Veterans Affairs Medical Center. “And smoking itself is clearly associated as a risk factor for cardiovascular disease.”

Stroke is another concern for RA patients.

"RA is an illness like diabetes. In and of itself, it's a risk factor for heart attack and stroke," says Andrew Ruthberg, MD, an assistant professor of medicine and an attending physician at Rush University Medical Center and director of Rush Rheumatoid Arthritis Clinic. "And those two things conspire to raise your risk for those other problems to a higher level."

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