Background/Purpose Smoking adversely influences comorbidities in rheumatoid arthritis (RA) and may affect progression of RA. The combination of negative health effects makes a compelling case for smoking cessation in RA. The aim of this pilot was to determine whether a targeted 3-month smoking cessation intervention for RA patients increases smoking cessation.

Methods Thirty-eight RA patients who were currently smoking were recruited and randomized on a 1:1 ratio. All participants were given the current local standard of care for smoking cessation (brief advice and subsidised nicotine replacement therapy: ABC). Participants randomized to the intervention arm (ABC+) received additional advice from trained Arthritis New Zealand educators for 3 months. Advice was tailored to participants’ specific needs from a range of intervention tools developed from previous qualitative consultation and focused on education about the relationship between smoking and RA, pain control, exercise, coping, and support. The primary outcome measure was smoking cessation at 6 months. The secondary outcome was sustained reduction in smoking at 6 months. The assessor was blind to intervention allocation. Disease and psychosocial characteristics of quitters and non-quitters were examined statistically.

Results Thirty-five participants completed the 6 month trial; the 3 who withdrew were in the intervention arm. The overall smoking cessation rate was 24%. There was no significant difference in smoking cessation rate between the ABC+ and ABC groups (26% vs 21%; P=0.70). The mean number of cigarettes smoked per day reduced by 56% (P<0.001) but did not differ between ABC+ and ABC groups (mean reduction 59% vs 53%; P=0.72). There was no difference in smoking cessation rates between participants with disease duration 2 years (27% vs 22%; P=0.74). Successful quitters had a greater number of years in education beyond high school and had smoked less across their lifetime, but these differences were not statistically significant.  The successful quitters did appear to have less severe disability and pain, and better psychosocial factors including less depression, perceived stress, and an enhanced quality of life but these did not reach statistical significance (Table 1). No other demographic, disease, or psychosocial variables predicted quitting.

Conclusion This pilot randomized controlled trial evaluated the effects of an individually tailored smoking cessation programme in patients with RA. The smoking cessation rate and reduction in number of cigarettes smoked were high compared to previous smoking cessation studies. The lack of added benefit of the tailored intervention suggests brief advice is the best practice supporting RA patients who wish to quit smoking. RA patients with fewer years of education or longer history of smoking may require particular cessation support.

 

Table 1: Baseline disease and psychosocial factors associated with smoking cessation. All data are presented as mean (SD)
Baseline disease and psychosocial factors*	Successful Quitters (n=9)	Non-quitters (n=29)	Total (n=38)	P
Education (years)	12.56 (1.88)	11.48 (1.33)	11.74 (1.52)	0.06
Cumulative pack-years of smoking (years)	25.58 (10.44)	41.68 (24.47)	37.76 (22.86)	0.07
Current age (years)	55.22 (12.34)	56.90 (11.83)	56.50 (11.80)	0.72
Socio-economic deprivation	5.00 (3.32)	5.31 (2.61)	5.24 (2.75)	0.77
ASES pain	6.87 (2.17)	6.15 (1.97)	6.32 (2.01)	0.36
ASES mood	7.54 (2.02)	7.15 (2.10)	7.24 (2.06)	0.62
HADS anxiety	6.67 (3.39)	6.72 (3.95)	6.71 (3.78)	0.97
HADS depression	3.67 (1.94)	4.79 (3.46)	4.53 (3.18)	0.36
PSS stress	19.00 (7.53)	22.48 (8.75)	21.66 (8.51)	0.29
HAQ	0.56 (0.42)	0.87 (0.77)	0.80 (0.71)	0.26
PI HAQ	1.95 (1.36)	2.45 (2.18)	2.33 (2.01)	0.52
EQ VAS	76.33 (15.64)	70.76 (19.23)	72.08 (18.40)	0.44
EQ-5D	0.73 (0.24)	0.65 (0.19)	0.67 (0.21)	0.31
Smoking self-efficacy internal	12.67 (5.94)	13.14 (6.35)	13.03 (6.18)	0.85
Smoking self-efficacy external	14.33 (3.46)	13.69 (6.15)	13.84 (5.60)	0.77
Fagerstrom Nicotine Dependence	3.78 (1.64)	4.03 (1.94)	3.97 (1.85)	0.72
*Abbreviations: ASES, Arthritis Self-Efficacy Scale; HADS, Hospital Anxiety and Depression Scale; PSS, Perceived Stress Scale; HAQ, Health Assessment Questionnaire; PI-HAQ, Personal Impact Health Assessment Questionnaire; EQ-VAS, Euroqol visual analogue scale; EQ-5D, Euroqol health utility

---

« Back to 2014 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/a-pilot-randomized-controlled-trial-of-a-tailored-smoking-cessation-intervention-for-rheumatoid-arthritis-patients/