title: Smoking, use of moist snuff, and risk of chronic inflammatory diseases.
abstract: BACKGROUND
  Cigarette smoking is emerging as a strong risk factor in the otherwise unknown etiology of chronic inflammatory diseases. Whether the same applies also to smokeless tobacco remains unknown. Nicotine is a powerful modifier of the inflammatory response. By comparing risks associated with tobacco smoking and with smokeless tobacco, the role of nicotine in the development of chronic inflammation may be evaluated.
  
  
  OBJECTIVE
  To assess and compare the risks of rheumatoid arthritis (RA), ulcerative colitis (UC), Crohn's disease (CD), sarcoidosis, and multiple sclerosis (MS) associated with cigarette smoking and with the use of Swedish moist snuff.
  
  
  METHODS
  We performed a cohort study of 277,777 males within a cohort of Swedish construction workers who had provided information about tobacco use in 1978-1993. Cross-linkage to the nationwide Swedish Hospital Discharge Register provided information about the occurrence of RA, UC, CD, sarcoidosis, and MS through 2004.
  
  
  RESULTS
  Age-adjusted relative risks (RRs) associated with smoking and moist snuff, respectively, were estimated by Cox regression. Ever-smoking was associated with an increased risk for RA (RR, 2.1; 95% confidence interval [CI], 1.7-2.5), CD (RR, 1.5; 95% CI, 1.2-1.8), MS (RR, 1.9; 95% CI, 1.4-2.6), and UC (RR, 1.3; 95% CI, 1.1-1.5, confined to ex-smokers), and a decreased risk of sarcoidosis (RR, 0.5; 95% CI, 0.4-0.5). By contrast, ever-use of moist snuff, adjusted for smoking, was not associated with RA (RR, 1.0; 95% CI, 0.9-1.2), UC (RR, 1.1; 95% CI, 0.9-1.2), CD (RR, 0.9; 95% CI, 0.8-1.1), sarcoidosis (RR, 1.1; 95% CI, 0.8-1.5), or MS (RR, 1.0; 95% CI, 0.8-1.4).
  
  
  CONCLUSIONS
  Smokeless tobacco does not increase the risk of chronic inflammatory diseases, suggesting that inhaled nonnicotinic components of cigarette smoke are more important than nicotine itself in the etiology of these diseases.
authors.affiliation: Rheumatology Unit, Department of Medicine, Karolinska Universitetssjukhuset Solna, SE-171 76 Stockholm, Sweden. cecilia.carlens@ki.se
authors.forename: Cecilia
authors.initials: C
authors.lastname: Carlens
authors.forename: Maria-Pia
authors.initials: MP
authors.lastname: Hergens
authors.forename: Johan
authors.initials: J
authors.lastname: Grunewald
authors.forename: Anders
authors.initials: A
authors.lastname: Ekbom
authors.forename: Anders
authors.initials: A
authors.lastname: Eklund
authors.forename: Caroline Olgart
authors.initials: CO
authors.lastname: Höglund
authors.forename: Johan
authors.initials: J
authors.lastname: Askling
mesh_terms: D000328:Adult; D001172:Arthritis, Rheumatoid / Q000453:epidemiology; D015331:Cohort Studies; D003093:Colitis, Ulcerative / Q000453:epidemiology; D003424:Crohn Disease / Q000453:epidemiology; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009103:Multiple Sclerosis / Q000453:epidemiology; D012042:Registries; D018570:Risk Assessment; D012507:Sarcoidosis / Q000453:epidemiology; D012907:Smoking / Q000009:adverse effects* / Q000453:epidemiology; D013548:Sweden / Q000453:epidemiology; D014030:Tobacco, Smokeless / Q000009:adverse effects*