Five reasons why you should offer
smoking cessation advice to your patients
There is a pressing need for heumatology health profes- sionals to educate their patients about the importance of smoking cessation, particularly as patients
begin to ask more about the impact
of smoking on disease outcomes,
delegates learned at the Congress.
In the session titled “How not to
smoke like a
chimney,” rheumatologist Helen
Harris of NHS
in Edinburgh presented research
to EULAR delegates illustrating that helping
smokers with rheumatic and musculoskeletal diseases to quit is achievable
and should be considered an essential
part of the rheumatology outpatient
Evidence shows that smoking has a
direct effect on inflammatory rheumatic diseases and increases the risk of
comorbidities, she said in an interview.
However, research shows that the
practice of offering smoking cessation
advice is highly variable across practices and countries. For example, a survey of rheumatologists in 25 countries
revealed that, although most doctors
give advice to quit smoking to most patients, only 20% had a specific protocol
for smoking cessation. Nurses also
gave cessation advice to most patients
in only one-third of departments that
had nurses providing patient education.
“There is a pressing and unmet
need to improve awareness amongst
rheumatologists of the importance of
smoking cessation advice for rheumatology patients,” Dr. Harris said.
“Smoking predicts higher inci-
dence, greater severity, and reduced
treatment responses in rheumatoid
arthritis, lupus, and spondyloarthritis,”
RA patients are also at a substantially
higher risk of lung cancer and other
airway diseases, making smoking ces-
sation “essential to effectively lower
cardiovascular disease, risk of lung
cancer, and other lung conditions in RA
patients who smoke.”
Dr. Harris set out her top five rea-
sons to offer brief smoking cessation
advice to rheumatology patients:
• Improve chances of response to
• Reduce infective risks of immunosuppressive therapy.
• Improve success of medication
• Reduce cardiovascular and respiratory diseases and cancer risks.
• Reduce mortality.
“Raising awareness of the harms
of smoking for rheumatology patients
is the first step in the cessation pathway and can be done effectively using
posters or postcards freely available
through www.nras.org.uk,” she added.
At the same session, Ida Kristiane
Roelsgaard from the Copenhagen Cen-
ter for Arthritis Research (COPECARE)
in Denmark took delegates through the
current state of evidence around the
benefits of smoking cessation.
According to Ms. Roelsgaard,
smoking cessation interventions have
traditionally been designed for people
without chronic diseases, which
means the literature on smoking ces-
sation interventions in people with
inflammatory joint diseases is limited.
“Why there is lack of research on
smoking cessation and inflammatory
joint diseases is difficult to answer.
... We do know that smoking can
worsen the disease outcomes and
patient-reported outcomes, so testing
the effect of smoking cessation and
smoking cessation interventions in
this patient group is important,” she
said in an interview.
At the moment, there is also no
current evidence around whether one
smoking cessation intervention works
better than another, but the good news
is that evidence in the area is increas-
ing, and patients are starting to ask
more questions about the impact that
smoking can have on their disease, as
well as the benefits of quitting. For ex-
ample, one key finding from her quali-
tative research was that smokers with
rheumatoid arthritis had a strong wish
for more of a focus on smoking cessa-
tion from their health professional.
People with rheumatoid arthritis
who participated in an ongoing ran-
domised, controlled trial testing an
intensive smoking cessation interven-
tion felt they had gained more knowl-
edge and acquired tools for changing
their smoking behaviour, even though
they did not immediately quit.
“They thought that the clinical
study was a positive approach from
the rheumatology department and
saw it as an opportunity to finally quit
smoking,” Ms. Roelsgaard explained.
Neither presenter had conflicts of
interest to disclose.
Dr. Harris Ms. Roelsgaard