Axial Spondyloarthritis Patients Who Stop Smoking Lower Disease Activity, Feel Better

Patients with axial spondyloarthritis (axSpA) who quit smoking have lower disease activity, better physical function, and a better quality of life than those who smoke, a study reports. Researchers call for targeted interventions to promote smoking cessation in patients with axSpA.

AxSpA is a group of disorders that includes ankylosing spondylitis. Disease severity in axSpA is known to be enhanced by smoking habits, but the good news is that quitting smoking appears to improve disease severity.

The study, “In axial spondyloarthritis, never smokers, ex-smokers and current smokers show a gradient of increasing disease severity – results from the Scotland Registry for Ankylosing Spondylitis (SIRAS),” was published in the journal Arthritis Care & Research.

The study included 946 patients from the Scotland Registry for Ankylosing Spondylitis who responded to the questionnaire by mail. Males accounted for 73.5% of the group analyzed, and the average age was 52 years.

Of the 946 respondents, 384 (40.6%) reported they had never smoked, 205 (21.7%) reported they were current smokers, and 357 (37.7%) declared themselves as ex-smokers.

Current smokers scored lower on the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI)  and the Bath Ankylosing Spondylitis Function Index (BASFI), two questionnaires that assess disease severity and ability to function, respectively.

These patients also reported a diminished quality of life, according to their answers on the Ankylosing Spondylitis Quality of Life questionnaire (ASQoL).

Ex-smokers, in turn, reported lower disease activity and significantly better quality of life compared to current smokers.

Ex-smokers, however, were more likely to have uveitis (an eye inflammation) than current smokers, a phenomenon the study could not explain.

The researchers pointed out that the lower scores in disease activity seen in patients who had quit smoking were substantial when compared to therapeutic approaches like intensive physiotherapy and treatment with biologic drugs.

“The proposed benefits are not insubstantial. In the current study, for example, the difference observed in disease activity [between ex-smokers and current smokers] is around 30% of the effect one might achieve with intensive physiotherapy, and 16% that of biologic therapy” the team wrote.

“Smokers with spondyloarthritis experience worse disease than those who are never smokers. However, this study provides new evidence that, among smokers, smoking cessation is associated with lower disease activity and better physical function and QoL [quality of life]” the team concluded.

Based on the results, researchers suggested that “clinicians should specifically promote smoking cessation as an adjunct to usual therapy in patients with spondyloarthritis.”