Impact of smoking and alcohol on rheumatic and musculoskeletal disease

The findings of 2 systematic reviews, published in the latest issue of RMD Open, have corroborated the negative effects of smoking on rheumatic and musculoskeletal diseases (RMDs)-specific outcomes. The researchers also concluded on the positive association between high alcohol consumption and elevated risk of flares in RA and gout.

The present study by Wieczorek et al. has highlighted the significance of behavioral modifications in preventing the progression of RMDs and reducing the associated comorbidities. The review results have found that smoking was significantly associated with adverse outcomes in RMD patients namely cardiovascular comorbidity, poorer response to RA treatment, higher disease activity and severity in early RA, and axial spondyloarthritis radiographic progression. Available studies on alcohol consumption in RA patients, reported a positive association between alcohol intake and radiographic progression, and also between the number and type of alcoholic beverages and the incidence of flares.

In concurrence with the current findings, a 2014 study by Chang et al. has found that the treatment response and drug survival were significantly compromised in heavy smokers who received anti-tumour necrosis factor (anti-TNF) therapy. This could be attributed to changes in serology and inflammatory systems, and factors impairing the pharmacological action of anti-rheumatic drugs.

The studies underscore the need to educate patients regarding the detrimental effects of smoking and alcohol consumption on symptoms, function, disease activity, disease progression and occurrence of comorbidities. Further studies are warranted to evaluate the effects of interventions intended to quit smoking and alcohol consumption on disease-specific outcomes.


  1. Wieczorek M, Gwinnutt JM, Ransay-Colle M, et al. Smoking, alcohol consumption and disease-specific outcomes in rheumatic and musculoskeletal diseases (RMDs): systematic reviews informing the 2021 EULAR recommendations for lifestyle improvements in people with RMDs. RMD Open. 2022;8(1):e002170.
  2. Chang K, Yang SM, Kim SH, Han KH, Park SJ, Shin JI. Smoking and rheumatoid arthritis. Int J Mol Sci. 2014 Dec 3;15(12):22279-95.