Though smoking increases the risk for severe rheumatoid arthritis (RA) and can reduce the effectiveness of RA treatment, rheumatologists rarely provide smoking-cessation counseling with their patients, according to a new paper co-authored by UW-CTRI Associate Director of Research Dr. Megan Piper.
 
The paper, published in the Journal of Clinical Rheumatology, looked at whether or not RA patients who smoke had their RA under control, and how that was related to the amount of counseling they received from their rheumatologist. Researchers found that rheumatologists provided smoking-cessation counseling with only 10 percent of RA patients who smoke. 
 
“We assumed that if a patient had their RA under control, then maybe their physician would try to tackle the next problem – smoking,” UW-CTRI Associate Director of Research Dr. Megan Piper said. “That wasn’t the case. If a patient’s RA wasn’t under control, their rheumatologist was more likely to address their smoking. This may have been an effort on the part of the provider to improve the patient’s RA by getting them to quit smoking.”
 
Doctors were also more likely to provide smoking-cessation counseling if the patient had other cardiovascular disease risk factors.
 
Piper, who collaborated with the research team led by Dr. Christie Bartels, a rheumatologist at UW Health, explained that this illustrates the importance of specialists intervening with their patients before they exhibit symptoms of cardiovascular disease.
                                                                                                                                
“We need systematic, proactive smoking-cessation counseling or referral processes in these clinics,” Piper said. “This is especially important in specialty clinics such as rheumatology, because smoking is related to the disease process that the patient is already being treated for, and that disease outcome and treatment response can be improved if the patient can quit smoking.”
 
A system-level change can work, Piper said, similar to what has been done in primary care, where electronic health records are used to guide interventions based on a patient’s smoking status.
 
“If we can do it in primary care, why can’t we do it in rheumatology or other specialty clinics?”