Cigarette smoking and the risk of rheumatoid arthritis among postmenopausal women:: Results from the Iowa Women’s Health Study

doi:10.1016/S0002-9343(02)01051-3

The American Journal of Medicine

Volume 112, Issue 6, 15 April 2002, Pages 465-471

https://doi.org/10.1016/S0002-9343(02)01051-3 Get rights and content

Abstract

Purpose

To determine whether cigarette smoking increases the risk of rheumatoid arthritis among postmenopausal women.

Subjects and methods

We followed a cohort of 31 336 women in Iowa who were aged 55 to 69 years in 1986 and who had no history of rheumatoid arthritis. Through 1997, 158 cases of rheumatoid arthritis were identified and validated based on review of medical records and supplementary information provided by physicians. Multivariable Cox proportional hazards regression was used to derive rate ratios (RRs) and 95% confidence intervals (CIs) for the association between cigarette smoking and rheumatoid arthritis.

Results

Compared with women who had never smoked, women who were current smokers (RR = 2.0; 95% CI: 1.3 to 2.9) or who had quit 10 years or less before study baseline (RR = 1.8; 95% CI: 1.1 to 3.1) were at increased risk of rheumatoid arthritis, but women who had quit more than 10 years before baseline were not at increased risk (RR = 0.9; 95% CI: 0.5 to 2.6). Both the duration and intensity of smoking were associated with rheumatoid arthritis. Multivariable adjustments for age, marital status, occupation, body mass index, age at menopause, oral contraceptive use, hormone replacement therapy, alcohol use, and coffee consumption did not alter these results.

Conclusion

These results suggest that abstinence from smoking may reduce the risk of rheumatoid arthritis among postmenopausal women.

Section snippets

Study cohort and follow-up

The Iowa Women’s Health Study is a prospective cohort study established in 1986 39, 40, 41, 42. In January 1986, a 16-page survey was mailed to 98 030 randomly selected women between the ages of 55 and 69 years who had a valid Iowa driver’s license (40). The survey was returned by 41 836 women, for a 43% response rate. There were only minor demographic differences between respondents and nonrespondents 39, 40. Data on cigarette smoking history that were obtained at baseline included age

Results

During 334 463 person-years of observation among the 31 336 women with no history of rheumatoid arthritis in 1986, there were 158 validated incident cases of rheumatoid arthritis. Diagnosis was based on either cumulative satisfaction of American College of Rheumatology criteria (n = 146; 92%) or diagnosis by a respondent’s rheumatologist (n = 139; 88%), or both.

Women who developed rheumatoid arthritis were younger at menopause and were more likely to smoke than were those who did not develop

Discussion

We observed an association between cigarette smoking and the development of rheumatoid arthritis among postmenopausal women. Based on a (multivariable adjusted) relative risk of 2.2 for current cigarette smoking and 1.3 for former smoking, and a smoking prevalence of 14% for current smoking and 19% for former smoking in Iowa women, we estimate that about 18% of rheumatoid arthritis in postmenopausal women can be attributed to smoking. The U.S. attributable risk may be even greater, because the

Acknowledgements

The authors wish to thank Robert B. Wallace for assistance in study design, Tom Georgou and Theresa Mitchell for performance of chart reviews, M. Paul Strottmann for adjudicating discordant charts, and Beth Myers for assistance with data processing. Lastly, we are indebted to the physicians who provided copies of medical records and, most importantly, to the many women and their families who continue to participate in the Iowa Women’s Health Study.

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^☆: Supported by a clinical science grant from the Arthritis Foundation and grant R01 CA39741 from the National Cancer Institute.

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Clinical studyCigarette smoking and the risk of rheumatoid arthritis among postmenopausal women:: Results from the Iowa Women’s Health Study☆

Abstract

Purpose

Subjects and methods

Results

Conclusion

Section snippets

Study cohort and follow-up

Results

Discussion

Acknowledgements

Rheum Dis Clin North Am

Semin Arthritis Rheum

Semin Arthritis Rheum

Contraception

Lancet

Am J Obstet Gynecol

Am J Obstet Gynecol

The mortality of rheumatoid arthritis

Arthritis Rheum

What happens to patients with rheumatoid arthritisthe long-term view

Clin Rheumatol

Survival in rheumatoid arthritis

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Twin concordance rates for rheumatoid arthritisresults from a nationwide study

Br J Rheumatol

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J Rheumatol

Rheumatoid arthritis in an urban South African negro population

Ann Rheum Dis

Genetic dissection of complex traits

Science

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Arthritis Rheum

HLA-linked rheumatoid arthritis

Am J Hum Genet

Genetic epidemiology of rheumatoid arthritis

Am J Hum Genet

Lifestyle and the risk of rheumatoid arthritiscigarette smoking and alcohol consumption

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Clinical study
Cigarette smoking and the risk of rheumatoid arthritis among postmenopausal women:: Results from the Iowa Women’s Health Study☆