Search tips
Search criteria 


Logo of annrheumdAnnals of the Rheumatic DiseasesVisit this articleSubmit a manuscriptReceive email alertsContact usBMJ
Ann Rheum Dis. 1990 December; 49(12): 980–982.
PMCID: PMC1004291

Lifestyle and the risk of rheumatoid arthritis: cigarette smoking and alcohol consumption.


In a search for aspects of behaviour related to oral contraceptive use which might explain the favourable effect of oral contraception on the onset of rheumatoid arthritis (RA), cigarette smoking and alcohol consumption were studied as possible risk factors. Information on cigarette smoking and alcohol consumption was obtained by interview at the first visit to the outpatient clinic of 135 young women with confirmed definite or classical RA of recent onset and 378 control patients with soft tissue rheumatism or osteoarthritis. The diagnosis in all patients was confirmed by at least two years of follow up. Of the patients with RA, 44/135 (33%) were current cigarette smokers compared with 181/378 (48%) of the controls. The percentage of smokers among the controls was similar to that of women smokers in the general population. The adjusted risk of RA in women who smoked at least one cigarette a day was 0.61 (95% confidence interval (CI) 0.42 to 0.89). Thirty one (23%) patients with RA and 137 (36%) controls were alcohol drinkers. The risk of RA in women who consumed alcohol at least once a day was 0.52 (95% CI 0.33 to 0.84). The low relative risk estimates for cigarette smoking and alcohol consumption were mutually independent and also independent of oral contraceptive use, the presence of the HLA-DR4 antigen, or a positive family history of RA. The low incidence of alcohol consumption in the patients with RA might be due to the discontinuation of alcohol consumption after disease onset. The low incidence of cigarette smoking in the patients might reflect a protective effect of cigarette smoking on RA onset, possibly induced by changes in the immune system.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (616K), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Baron JA. Smoking and estrogen-related disease. Am J Epidemiol. 1984 Jan;119(1):9–22. [PubMed]
  • Daniell HW. Osteoporosis of the slender smoker. Vertebral compression fractures and loss of metacarpal cortex in relation to postmenopausal cigarette smoking and lack of obesity. Arch Intern Med. 1976 Mar;136(3):298–304. [PubMed]
  • Baron JA, Byers T, Greenberg ER, Cummings KM, Swanson M. Cigarette smoking in women with cancers of the breast and reproductive organs. J Natl Cancer Inst. 1986 Sep;77(3):677–680. [PubMed]
  • Miller LG, Goldstein G, Murphy M, Ginns LC. Reversible alterations in immunoregulatory T cells in smoking. Analysis by monoclonal antibodies and flow cytometry. Chest. 1982 Nov;82(5):526–529. [PubMed]
  • Barton SE, Maddox PH, Jenkins D, Edwards R, Cuzick J, Singer A. Effect of cigarette smoking on cervical epithelial immunity: a mechanism for neoplastic change? Lancet. 1988 Sep 17;2(8612):652–654. [PubMed]
  • Persellin RH. The effect of pregnancy on rheumatoid arthritis. Bull Rheum Dis. 1976;27(9):922–927. [PubMed]
  • Hazes JM, Dijkmans BC, Vandenbroucke JP, de Vries RR, Cats A. Reduction of the risk of rheumatoid arthritis among women who take oral contraceptives. Arthritis Rheum. 1990 Feb;33(2):173–179. [PubMed]
  • WOOLF B. On estimating the relation between blood group and disease. Ann Hum Genet. 1955 Jun;19(4):251–253. [PubMed]
  • Bradlow A, Mowat AG. Alcohol consumption in arthritic patients: clinical and laboratory studies. Ann Rheum Dis. 1985 Mar;44(3):163–168. [PMC free article] [PubMed]
  • Michnovicz JJ, Hershcopf RJ, Naganuma H, Bradlow HL, Fishman J. Increased 2-hydroxylation of estradiol as a possible mechanism for the anti-estrogenic effect of cigarette smoking. N Engl J Med. 1986 Nov 20;315(21):1305–1309. [PubMed]
  • Khaw KT, Tazuke S, Barrett-Connor E. Cigarette smoking and levels of adrenal androgens in postmenopausal women. N Engl J Med. 1988 Jun 30;318(26):1705–1709. [PubMed]
  • Grossman CJ. Regulation of the immune system by sex steroids. Endocr Rev. 1984 Summer;5(3):435–455. [PubMed]
  • Ansar Ahmed S, Penhale WJ, Talal N. Sex hormones, immune responses, and autoimmune diseases. Mechanisms of sex hormone action. Am J Pathol. 1985 Dec;121(3):531–551. [PubMed]
  • Spector TD, Blake DR. Effect of cigarette smoking on Langerhans' cells. Lancet. 1988 Oct 29;2(8618):1028–1028. [PubMed]

Articles from Annals of the Rheumatic Diseases are provided here courtesy of BMJ Publishing Group