SP0089 CONSEQUENCES OF SMOKING CESSATION IN RHEUMATOLOGY
Authors: Helen Harris
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background:</h3> Cigarette smoking is a risk factor for many autoimmune and inflammatory conditions including rheumatoid arthritis (RA), psoriasis and psoriatic arthritis (PsO PsA), is linked with active skin disease in patients with systemic lupus erythematosis (SLE) and poorer outcomes in patients with ankylosing spondylitis (AS) and systemic sclerosis (SSc). In addition there are well established risks of cardiovascular and respiratory diseases and increased risk of at least 13 cancers in patients that smoke [1]. Patients continuing to smoke after RA is diagnosed often fail to respond or require higher doses of immunosuppressive medications [2]. When arthritis is in remission and biologic dose reduction is attempted, patients that continue to smoke are more likely to have a flare of arthritis after dose reduction [3]. Patients that quit smoking can reduce or stop immunosuppressive medications without experiencing a flare [4]. Smokers have higher rates of infection than non-smokers; immunosuppressive therapy has an increased risk of infection and smoking cessation when starting treatment such as methotrexate or anti-TNF inhibitors can reduce the risk of infection [5]. The five top reasons to deliver brief smoking cessation advice to rheumatology patients are: 1. Improve chances of response to therapy. 2. Reduce infective risks of immunosuppressive therapy. 3. Improve success of medication dose reduction. 4. Reduce cardiovascular and respiratory diseases and cancer risks. 5. Reduce mortality. <h3>Objectives:</h3> To demonstrate how brief smoking cessation advice can be delivered in rheumatology outpatient clinics and to show the consequences that this has had for patients, the rheumatology team and the wider healthcare system. <h3>Methods:</h3> Delivering a brief intervention on smoking cessation by saying to smokers "Do you know the best way to quit? Use Champix (Varenicline) or Nicotine Replacement Therapy" is an evidence based way to motivate a quit attempt that takes 30 seconds to deliver. A 50 minute talk was presented to the rheumatology team of doctors, nurses and allied health professionals explaining this method of delivering brief advice on smoking cessation. We have made brief advice easy to deliver in the rheumatology clinic by creating a pathway for referral of smokers to the community pharmacist and smoking cessation nurse. A questionnaire has been administered to the rheumatology team to explore their attitudes and beliefs about delivering smoking cessation advice in the rheumatology clinic. <h3>Results:</h3> The referral figures for the smoking cessation pathway will be presented. The consequences of delivering brief advice on smoking cessation for the patients, rheumatology team and healthcare system will be reported. <h3>Conclusion:</h3> This presentation will show that helping rheumatology smokers to quit is achievable and should be considered an essential part of the rheumatology outpatient consultation. <h3>References:</h3> [1] Arnson Y, Shoenfeld Y, Amital H. Effects of tobacco smoke on immunity, inflammation and autoimmunity. Journal of Autoimmunity 34 (2010) J258eJ265. [2] Harris H, Tweedie F, White M, Samson K. How to persuade patients with Rheumatoid Arthritis to quit smoking. J Rheumatol. 2016 Apr;43(4):691-8. doi: 10.3899/jrheum.141368. Epub 2016 Feb 15. [3] Gibson J, Harris H, McLaren J. Dose reduction of biologic therapies. EULAR OP0161 June 2012 [4] Andersson M, Bergman S et al, for the BARFOT Study Group § The Effect of Stopping Smoking on Disease Activity in Rheumatoid Arthritis (RA). Data from BARFOT, a Multicenter Study of Early RA. Open Rheumatol J. 2012; 6: 303–309. [5] Arcavi L, Benowitz NL. Cigarette smoking and infection. Arch Intern Med. 2004 Nov 8;164(20):2206-16. <h3>Disclosure of Interests:</h3> None declared