RESUMO
The aim of the present work was to study the effect of tobacco smoking on disease progression in rheumatoid arthritis patients and its relation to anti-cyclical citrullinated peptide [anti-CCP] antibodies. The study included 54 patients; 20 non-smokers, 9 ex-smokers, 14 mild to moderate smokers and 11 heavy smokers. Fifteen normal volunteers were also studied as controls. Disease stage was clinically and radiologically determined, rheumatoid factor [RF] and anti-CCP antibodies were measured in serum. Higher percentage of severe disease [stage III] was seen in heavy smokers patients than mild to moderate smokers [54.6% versus 35.7%] and in moderate smokers than ex-smokers [35.7% versus 33.6%]. Lowest percentage of severe disease was seen in non-smokers [15%]. RF and anti-CCP were significantly higher in smoker than non-smoker and in heavy than mild to moderate smoker patients [p<0.01, p<0.05 and p<0.01, p<0.001, respectively]. In smoker patients, both RF and anti-CCP antibodies correlated significantly and positively with smoking index [r= 0.581, p<0.001; r= 0.661, p<0.001]. Also, smoking index and anti-CCP correlated significantly and positively with disease stage [r=0.424, p<0.05; r=0.523, p<0.01]. It appears from our results that, tobacco smoking mostly play a role progression of rheumatoid arthritis through tissue protein citrullination. So all rheumatoid arthritis patients must quit completely to achieve a good control