Why does tobacco use increase the risk of rheumatoid arthritis?

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Why does tobacco use increase the risk of rheumatoid arthritis?

Filed under: Tobacco

By: Nathan Wei, MD

Multiple studies have demonstrated the phenomenon that tobacco exposure increases the risk of developing rheumatoid arthritis. Moreover, smokers tend to have more severe disease. This article discusses some of the most recent data.

Smokers are more prone to developing rheumatoid arthritis (RA) and for also having more severe RA.

Certain genetic markers called the HLA shared epitope predispose to the development of anti-cyclic citrullinated peptide antibodies (anti-CCP antibodies). Anti-CCP antibodies are very specific for RA, precede the development of RA, and are also associated with more serious disease.

A recent Dutch study has shown that the shared genetic epitopes differ in their interaction with tobacco exposure and with the subsequent development of anti-CCP antibodies.

Certain shared epitope patterns are associated with the tendency to form anti-CCP antibodies.

Tobacco exposure is also associated with an increased tendency to form anti-CCP antibodies.

When the shared epitopes that are associated with increased anti-CCP come in contact with tobacco, then the amount of anti-CCP is increased many-fold.

It appears that tobacco exposure plus the high risk HLA shared epitope, leads to an excessive production and presentation of citrullinated proteins. These proteins are then presented to T lymphocytes which sets off an autoimmune response. The more citrullinated proteins that are presented to the T cells, the more likely the autoimmune response is to perpetuate itself.

The moral of the story: If you have a family history of RA, avoid tobacco products.

Van der Helm-van Mil A, Verpoort KN, le Cessie S, Huizinga TWJ, de Vries RRP, Toes REM. The HLA-DRB1 Shared Epitope Alleles Differ in the Interaction with Smoking and Predisposition to Antibodies to Cyclic Citrullinated Peptide. Arthritis Rheum. 2007; 56 (2): 425-432.

Nathan Wei, MD, FACP, FACR is a rheumatologist and Director of the Arthritis and Osteoporosis Center of Maryland (http://www.aocm.org). He is a Clinical Assistant Professor of Medicine at the University of Maryland School of Medicine and consultant to the National Institutes of Health. For more info: {a href=" http://www.arthritis-treatment-and-relief.com/arthritis-treatment.html"}Arthritis Treatment