Smoking and comorbidities in rheumatoid arthritis: what we know and what we can do

Cigarette smoking continues to be a major health hazard contributing significantly to morbidity and mortality worldwide. Cigarette smoking is a shared risk factor for rheumatoid arthritis (RA) and many of its comorbidities. Consequently, RA patients suffer the morbidity of cumulative disease burden as well as excess mortality. This review explores and summarizes existing evidence of the complex interplay between smoking and common comorbidities in rheumatoid arthritis including cardiovascular disease, respiratory disease, malignancies, osteoporosis and periodontitis. As disease modifying therapies continue to reduce direct disability from RA, there is increasingly greater scope to improve quality and duration of life by optimizing comorbid diseases. Smoking cessation advice should feature in all consultations.