SMOKING AND DEVELOPMENT OF RHEUMATOIS ARTHRITIS: PATHOGENETIC PUZZLES COMPLETION
Summary. The article presents current data on correlations between smoking and rheumatoid arthritis. Numerous studies over the past 20 years, strongly suggest that cigarette smoking is associated with a high risk of developing rheumatoid arthritis both among women and among men, as well as demonstrate links between smoking and citrullined antibodies and rheumatoid arthritis. With women who smoked for more than 20 years, the risk of rheumatoid arthritis was increased by 24–39% and the risk of seropositive rheumatoid arthritis — by 30–49%, depending on the number of smoked cigarettes per day. We prove a significant relationship between smoking and severity of the disease, the number of erosions, the appearance of rheumatoid nodules, including those with early rheumatoid arthritis. The risk of developing rheumatoid arthritis to a greater degree associates with duration of smoking rather than the intensity, however, harmful effects of smoking with regards to arthritis development is only neutralized 10–20 years after smoking cessation. The data show a clear correlation between the HLA-DRB1 SE genotype and the development of RF-positive and ACCP-positive rheumatoid arthritis, while the risk of development of ACCP-positive rheumatoid arthritis among smokers with two alleles, compared with non-smokers without SE-alleles increased more than in 20 times. Thus, smoking is an important etiologic risk factor for autoimmune diseases, particularly rheumatoid arthritis. Consequently, it is extremely important to inform patients about harmful effects of smoking in the development and progression of rheumatoid arthritis.
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