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Cigarette smoking associates with body weight and muscle mass of patients with rheumatoid arthritis: a cross-sectional, observational study

Antonios Stavropoulos-Kalinoglou123*, Giorgos S Metsios123, Vasileios F Panoulas3, Karen MJ Douglas3, Alan M Nevill12, Athanasios Z Jamurtas45, Marina Kita3, Yiannis Koutedakis145 and George D Kitas236

  • * Corresponding author: Antonios Stavropoulos-Kalinoglou

Author Affiliations

1 School of Sport, Performing Arts & Leisure, Wolverhampton University, Gorway Road, Walsall, WS1 3BD, West Midlands, UK

2 Research Institute in Healthcare Science, University of Wolverhampton, Wulfruna Street, Wolverhampton, WV1 1LY, West Midlands, UK

3 Department of Rheumatology, Dudley Group of Hospitals NHS Trust, Russell's Hall Hospital, Pensnett Road, Dudley, DY1 2HQ, West Midlands, UK

4 Department of Sport and Exercise Science, University of Thessaly, Trikala-Karyes Road, Trikala, 42100, Greece

5 Institute of Human Performance & Rehabilitation, Trikala-Karyes Road, Trikala, 42100, Greece

6 ARC Epidemiology Unit, University of Manchester, Oxford Road, Manchester, M13 9PT, UK

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Arthritis Research & Therapy 2008, 10:R59  doi:10.1186/ar2429

Published: 20 May 2008



Rheumatoid arthritis (RA) is associated with altered metabolism leading to muscle wasting. In the general population, cigarette smoking is known to affect body composition by reducing fat and inhibiting muscle synthesis. Even though smoking has been implicated in the pathophysiology and progression of RA, its possible effects on body composition of such patients have not been studied. This cross-sectional study aimed to identify potential associations of smoking with body weight and composition of RA patients.


A total of 392 patients (290 females) with RA were assessed for body mass index (BMI), body fat (BF), fat-free mass (FFM), and waist circumference. Erythrocyte sedimentation rate, C-reactive protein, Disease Activity Score-28, and Health Assessment Questionnaire score were used to assess disease activity and severity. Smoking habit (current smoker, ex-smoker, or never-smoker) and intensity (pack-years) were also noted.


Current smokers had a significantly lower BMI compared with ex-smokers (mean difference: male -2.6, 95% confidence interval [CI]: -3.5 to -1.7; female: -2.6, 95% CI: -4.8 to -0.5) and never-smokers (mean difference: male -1.8, 95% CI: -3 to -0.6; female: -1.4, 95% CI: -2.4 to -0.4). Similarly, the BF of current smokers was lower compared with that of ex-smokers (mean difference: male: -4.3, 95% CI: -7.5 to -1.2; female: -3.4, 95% CI: -6.4 to -0.4) and never-smokers (mean difference: male: -3.3, 95% CI: -6.3 to -0.4; female: -2.1, 95% CI: -4 to -0.2). FFM did not differ between groups. Finally, current smokers had a significantly smaller waist circumference compared with ex-smokers only (mean difference: male: -6.2, 95% CI: -10.4 to -1.9; female: -7.8, 95% CI: -13.5 to -2.1). Following adjustments for age, disease duration, and HAQ score, smoking remained a significant predictor for BMI (P < 0.001), BF (P < 0.05), and waist circumference (P < 0.05). Pack-years were inversely correlated with BF (r = -0.46; P < 0.001), and heavy smokers exhibited a significantly lower FFM (P < 0.05) compared with all other participants.


Within the limitations of a cross-sectional study, it appears that cigarette smoking associates with reduced BMI and BF in patients with RA and heavy smoking associates with lower muscle mass. Smoking cessation appears to associate with increased BMI, BF, and waist circumference in these patients. These results should be confirmed in prospective studies. Given the numerous adverse effects of smoking on general health and RA, patients should be actively advised against it. However, smoking cessation regimes in RA may need to include more general lifestyle counselling, particularly about weight control.