Cigarette smoking habits and attitudes among rheumatoid arthritis patients at a tertiary centre in South Africa

Abstract

Background: People living with rheumatoid arthritis (RA) who smoke cigarettes are known to have worse outcomes with regard to disease control, extra-articular complications and comorbidities. Data regarding this from sub-Saharan Africa is lacking. This study aims to describe the prevalence of cigarette smoking and explore disease control, comorbidities and attitudes of smoking among RA patients in an outpatient clinic at a tertiary hospital.
Methods: A cross-sectional study of consenting adult outpatients with RA was conducted. Demographic, clinical and patient-reported outcome measures, together with a questionnaire about smoking and Fagerström test for nicotine dependence, were collated.
Results: Of 632 patients (536 female participants), the mean (standard deviation) age and disease duration were 55.4 (13.0) and 10.1 (9.3) years, and 74.1% had two or more comorbidities. Of 218 (34.5%) smokers, more men smoked (p = 0.0002). Compared to non-smokers, smokers had lower body mass index (p = 0.01), higher incidence of chronic obstructive pulmonary disease (p < 0.005) and rheumatoid factor positivity (p = 0.006), and higher anxiety scores (p = 0.048) with more impairment in usual activities (p = 0.05). No significant differences in disease activity, extra-articular disease, or in disability, fatigue, depression, or pain scores were observed. The most common reasons for smoking were emotional support (45.8%), nicotine craving (30.5%) and pain control (25.2%). The Fagerström score revealed mild, moderate and severe nicotine dependence in 67.5%, 24.4%, and 7.5%, respectively.
Conclusion: One in three patients with RA actively smoked. Those who smoked had more pain, anxiety, and depression but with low nicotine dependency scores.
Contribution: The approach to tobacco cessation should occur in parallel with optimal pain, behavioural support and disease control.