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RA patients who used snuff had lower initial DAS28 than ex-smokers, those who never smoked
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Patients with rheumatoid arthritis who used smokeless tobacco initially had a lower Disease Activity Score 28 than patients who were previous smokers or who had never smoked, according to study results.
Researchers mailed questionnaires to 2,102 adult patients who were part of an early rheumatoid arthritis (RA) study in Sweden. Based on responses, researchers identified 51 patients (median age, 55 years; 75% men) who used moist, smokeless tobacco or “snuff.” They also identified three control groups totaling 145 patients: never-smoking (n=49; median age, 53 years; 74% men), previous-smoking (n=48; median age, 52 years; 71% men) and current-smoking (n=48; median age, 55 years; 71% men). Patients who used snuff and smoked were labeled smokers.
In the earlier RA study, Disease Activity Score 28 (DAS28), Health Assessment Questionnaire, visual analog scale for general health, and drug treatment were registered at inclusion and at follow-up after 1, 2 and 5 years. At 1 year, European League Against Rheumatism (EULAR) response and remission criteria were applied.
When adjusted for socioeconomic class, disease duration and previous antirheumatic medication, snuff users had lower mean DAS28 values compared with RA patients who had never smoked at 3 months (2.0 vs. 3.7; P=.001) and at 6 months (2.1 vs. 3.2; P=.003). The smokeless tobacco patients also had lower mean DAS28 values than previous smokers at 2 years of follow-up (2.0 vs. 2.9; P=.02). Compared with smokers in the adjusted model, snuff users had a lower mean DAS28 (2.5 vs. 4.1; P=.01) at 3 month follow-up. At up to 1 year, snuff use had no effect on EULAR response.
“Our study results can obviously not be used to promote using snuff, as its use has been shown to be associated with a risk of cardiovascular disease and with lethal myocardial events in some studies. Snuff is thus not a ‘healthier’ product than cigarettes,” the researchers reported. “Our results must be verified in larger studies.”
Disclosure: See the study for a full list of relevant disclosures.
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