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Smoking linked to negative disease progression from smoking

Smokers have poorer treatment adherence

University of Alabama at Birmingham researchers found in a diabetic mouse study cotinine levels had kidney scarring & more proteinuria markers of kidney damage.
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Psoriatic arthritis smokers had worse baseline patient-reported outcomes, shorter treatment adherence and poorer response to TNFi's compared to non-smokers, according to a new study by 'Danish researchers.
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Psoriatic arthritis (PsA) is a type of chronic inflammatory arthritis associated with the chronic skin condition psoriasis, which is believed to be an inherited condition. Psoriasis affects about two percent of the U.S. population. Estimates indicate that between 10% to 30% of people with psoriasis also have psoriatic arthritis.

In this new study researchers from ‘Denmark examined the association between tobacco smoking and disease activity, treatment adherence and treatment responses among patients with psoriatic arthritis.

For this study researchers examined data from Danish nationwide DANBIO registry. That included 3,000 biological treatment course of close to 90% of Danish patients in the registry.

The analysis included 1,388 patients with psoriatic arthritis with 33% current smokers, 41% never smoked and 26% past smokers. All participants had started treatment with Enbrel, Remicade and Humira.

Even though smoking did influence disease features as reported by patients, smoking had a lesser effect on swollen joint count and C-reactive protein level.

Using the response criteria of the European League Against Rheumatism (EULAR), good responses were seen in 34% of participants who never smoked compared to 23% of current smokers.

Responses were most pronounced in men with EULAR good responses at 42% for those who never smoked, compared to 24% of current smokers.

Current smokers had a shorter treatment adherence at 1.56 years compared to 2.43 years of those who never smoked.

In current smokers the treatment adherence was poorer for Remicade (1.62), Enbrel (1.74) compared to those who never smoked. Poorer treatment adherence was not found in Humira.

The research team noted that patients who stopped smoking for over four years prior to beginning treatment had shown similar rates of treatment adherence as those who never smoked.

"This may illustrate a gradual normalization of pathological processes and smoking-related behavior, and is noteworthy, as tobacco smoking is a potentially modifiable lifestyle factor," note the researchers.

They also noted that the possible reversibility of the negative influence of smoking on disease and treatment highlights the need for clinicians to encourage patients to quit

This study appears in the Annals of the Rheumatic Diseases

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