Smoking Worsens Ankylosing Spondylitis Damage
Quitting linked to less severe disease, better function and quality of life
“The effect of quitting was more pronounced among men. We don’t know for sure why this is,” Dr. Zhao says. “Men and women may report their symptoms differently; also, men tender to be heavier smokers than women. This study did not report a ‘dose effect’ of smoking, but other studies, have shown that greater intensity of smoking is associated with worse outcomes in AS.”
Other research in AS, including a 2018 Arthritis Care & Research study, has reported that smoking in men – but not in women – is linked to more rapidly progressing disease. That study also linked the habit in men to development of bony growths called syndesmophytes that lead to spinal fusion, which causes a loss of flexibility and chronic pain.
Scientist aren’t sure how smoking contributes to poorer outcomes in AS. Many think inflammation caused by smoke inhalation plays a role in speeding up disease-related damage.
“Since smokers are also more likely to have other lifestyle and health factors that are bad for their AS, it is difficult to untangle the effects of smoking from these other factors,” says Dr. Zhao, who stresses that people with the condition who smoke should quit.
Quitting Slows Down Damage
Quitting does improve the clinical picture, however.
The study found that people with AS who stopped smoking had lower levels of disease activity and better function and quality of life than current smokers. Study investigators estimated that the benefits of stopping smoking were roughly equivalent to 30 percent and 16 percent, respectively, of the effects patients might get with intensive physical therapy and treatment with biologic medications.
“Smoking is bad for health in general. It increases risk of heart disease, cancer, and rheumatoid arthritis,” Dr. Zhao says. “Almost all patients with rheumatic diseases, including AS, have a higher risk of cardiovascular diseases. Since smoking greatly increases cardiovascular risk, cessation should be universally recommended and promoted, along with other healthy lifestyle changes such as diet and exercise.”
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