OP0156-HPR THE EFFECT OF A PERSON-CENTERED SMOKING CESSATION PROGRAM IN RHEUMATOID ARTHRITIS PATIENTS IN A RHEUMATOLOGY OUTPATIENT CLINIC SETTING – RESULTS OF AN INTERVENTIONAL FEASIBILITY STUDY
Authors: M. L. Karlsson, K. Hertzberg-Nyquist, S. Saevarsdottir, I. E. Lundberg, I. Demmelmaie, S. Pettersson, K. Chatzidionysiou
Journal: Annals of the Rheumatic Diseases (2021)

Background: Smoking is associated with worse treatment response 1 and higher mortality 2 in rheumatoid arthritis (RA). Objectives: To assess the effect of a smoking cessation intervention in a rheumatology setting. Methods: We designed a smoking cessation interventional feasibility study. RA patients who were active smokers were asked to participate. A nurse-delivered program consisting of behavioural changes techniques and voluntary pharmacotherapy was executed. The intervention was at baseline and at several time points during a 24 month period, based on the individual patient’s needs. Smoking status was collected at baseline, 6, 12, 18 and 24 months. Smoking cessation was verified by 7-days abstinence and carbon monoxide in expiratory air. The main outcome was the proportion of patients who quit smoking (QS) at 24 months. Results: A total of 99 patients were included in the study between 2011-2020. Median (IQR) age of patients was 58 (50 - 64), 69 % were female and 82% were RF and/or ACPA positive. 59% of patients had a newly diagnosed RA, (included from the early RA-track), with a median (IQR) symptom duration of 5 (2-9,5) months. Patients with established RA 41% (included from regular rheumatology department) had a median disease duration of 4 (2-8) years. After 24 months 21% quit smoking (QS) (Table 1). At months 6, 12, 18 and 24 the proportion of QS patients was 12, 13, 15 and 21, respectively. The proportion of QS patients at month 12 and continued being in the QS group throughout the study period was 10%. In the subgroup of patients who continued smoking (CS) the median number of cigarettes per day was significantly reduced at all follow-up time points (Table 1). No significant differences were observed at baseline between CS at 24 months and QS, apart from the proportion of patients who reported anxiety (extracted from EQ-5D and defined as absent or present), which was significantly fewer in the QS group (Table). In the QS group at month 24, the proportion of females was numerically lower compared to CS (52% vs. 73%, p=0.07). Table 1. Baseline demographical, clinical characteristics and number of cigarettes at specific time-points for patients who were non-smokers (QS) and smokers (CS) at month 24. QS N=21 (21% ) CS N=78 (79% ) Difference between QS and CS (p-value ) Age*(median, IQR ) 60 (53-62) 57 (50-64) 0.94 Symptom duration in early RA patients (months) (median, IQR ) 6 (2-12) 4.5 (2-8.5) 0.49 Disease duration of patients with established RA (years) (median, IQR ) 8 (3.5-16.5) 3 (2-6) 0.12 % females 52 73 0.07 % RF and/or ACPA positive 85 81 0.70 DAS28* (median, IQR ) 4.24 (3.13-5.72) 4.11 (2.88-5.36) 0.69 HAQ* (median, IQR ) 0.75 (0.25 -1.38) 0.88 (0.38-1.25) 0.74 VAS pain* (median, IQR ) 46.0 (11-60) 34.5 (12-70) 0.90 % of patients with reported anxiety* (part of EQ5D ) 28 58 0.02 Smoking duration (years ) (median, IQR ) 40 (30-50) 40 (34-49) 0.92 Median number of cigarettes per day - at baseline 10 (7-15) 12 (10-20) 0.22 - at 6 months 0 (0-3) 6 (3-10) 0.006 - at 12 months 0 (0-5) 6 (3-10) 0.0003 - at 18 months 0 (0-0) 6 (2-10) 0.00 - at 24 months 0 (0-0) 6 (3-10) 0.00 *=measured at baseline Conclusion: Smoking cessation intervention in a rheumatology clinic setting may facilitate reduced smoking or complete cessation in patients with RA. Patient who did not report anxiety were more likely to quit smoking. References: [1]Saevarsdottir, S., et al (2011). Patients with early rheumatoid arthritis who smoke are less likely to respond to treatment with methotrexate and tumor necrosis factor inhibitors: observations from the Epidemiological Investigation of Rheumatoid Arthritis and the Swedish Rheumatology Register cohorts. Arthritis Rheum, 63 (1), 26-36. [2]Joseph, R´., et al (2016) Smoking-Related Mortality in Patients With Early Rheumatoid Arthritis: A Retrospective Cohort Study Using the Clinical Practice Research Datalink Arthritis Care Res (Hoboken) 68 (11) 1598-1606 Acknowledgements: This study was partly funded by grants from Swedish Reumatism Association. Disclosure of Interests: Marie-Louise Karlsson Speakers bureau: MLK has recivied fee form Novartis Sverige AB, Grant/research support from: MLK had recivied finical grants from Novartis Sverige. Abbvie has fincial support brochure wich was used in the study, Katarina Hertzberg-Nyquist: None declared, Saedis Saevarsdottir Employee of: S is a part-time employee of deCODE genetics Inc., unrelated to this work., Ingrid E. Lundberg Consultant of: I Lundberg har recieved consulting fees from Corbus Pharmaceutical, EMD Serono Research &amp; Development Institute, Octapharma AG, Orphazyme, Janssen, Kezar Life Sciences Inc., Ingrid Demmelmaie: None declared, Susanne Pettersson: None declared, Katerina Chatzidionysiou Consultant of: KC has received consultancy fees from Eli Lilly, AbbVie and Pfizer.