Conséquences du tabac sur le devenir de la polyarthrite rhumatoïde

Tobacco, that is a well-known risk factor for rheumatoid arthritis (RA) development, can have an impact on disease outcome. Data are rather well-documented about active smoking. Concerning disease activity, there are contradictory results. While smoking is associated to a more important articular and systemic activity in early RA, it is not predictive of a persistent disease activity. In terms of disease severity, current smoking is not related to a higher radiographic progression and would have “protective effects”. But it enhances the occurrence of extra-articular manifestations (nodules, interstitial lung disease, periodontitis, vasculitis) and increases the risk of severe infections, periprosthetic joint infection, lung cancer and mortality. Whatever the immunological status, smoking is linked to a lower response to methotrexate and to the 3 TNF-blocking agents (infliximab, etanercept and adalimumab) that have been assessed until now. No informations are available about the other biologic agents. Moreover, remission and drug survival rates are lower under tobacco exposure. Nevertheless, active smoking has no deleterious effect in case of dose reduction or drug discontinuation. Although smoking cessation, which is an objective difficult to achieve because of several well-identified brakes, does not modify disease activity, its interest remains to reduce the appearance of extra-articular manifestations, severe infections and the risk of premature mortality due to cardiorespiratory comorbidities or cancer.