title: Smoking intensity, duration, and cessation, and the risk of rheumatoid arthritis in women.
abstract: BACKGROUND
  Cigarette smoking has been associated with rheumatoid arthritis (RA), but the importance of smoking intensity, duration, and time since quitting, and whether the risk is primarily for rheumatoid factor (RF) seropositive versus seronegative RA are still unclear.
  
  
  METHODS
  We conducted a prospective analysis of smoking and the risk of RA among 103,818 women in the Nurses' Health Study. A total of 680 RA cases, diagnosed from 1976 and 2002, were confirmed using a questionnaire and medical record review. Sixty percent were RF positive. Cox proportional hazards models calculated the relative risks (RRs) of RA with smoking, adjusting for reproductive and lifestyle factors.
  
  
  RESULTS
  The RR of RA was significantly elevated among current (RR 1.43 [95% confidence interval 1.16-1.75]) and past smokers (RR 1.47 [95% confidence interval 1.23-1.76]), compared with never smokers. The risk of RA was significantly elevated with 10 pack-years or more of smoking and increased linearly with increasing pack-years (P trend <.01). A greater number of daily cigarettes and longer duration of smoking were associated with increased risk. The effect of smoking was much stronger among RF-positive cases than among RF-negative cases. The risk remained elevated in past smokers until 20 years or more after cessation.
  
  
  CONCLUSIONS
  In this large cohort, past and current cigarette smoking were related to the development of RA, in particular seropositive RA. Both smoking intensity and duration were directly related to risk, with prolonged increased risk after cessation.
authors.affiliation: Division of Rheumatology, Immunology, and Allergy, Robert B. Brigham Arthritis and Musculoskeletal Diseases Clinical Research Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass 02115, USA. KCostenbader@partners.org
authors.forename: Karen H
authors.initials: KH
authors.lastname: Costenbader
authors.forename: Diane
authors.initials: D
authors.lastname: Feskanich
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Mandl
authors.forename: Elizabeth W
authors.initials: EW
authors.lastname: Karlson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001172:Arthritis, Rheumatoid / Q000453:epidemiology* / Q000209:etiology* / Q000276:immunology; D015415:Biomarkers / Q000097:blood; D015986:Confounding Factors, Epidemiologic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D015999:Multivariate Analysis; D009726:Nurses / Q000706:statistics & numerical data; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012217:Rheumatoid Factor / Q000097:blood; D018570:Risk Assessment; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects* / Q000453:epidemiology*; D016540:Smoking Cessation; D011795:Surveys and Questionnaires; D013997:Time Factors; D014481:United States / Q000453:epidemiology
chemical_list: D015415:Biomarkers; D012217:Rheumatoid Factor