To the Editor:
We have noted a 1.5 relative risk (RR) of people with inflammatory arthritis failing at least one anti-tumor necrosis factor (TNF) therapy and a 1.6 RR of failing disease-modifying antirheumatic drug (DMARD) therapy if they are “ever-smokers” (current or past smokers). This is based on a prospective longitudinal analysis of 793 patients, of whom 102 (13%) were deemed to have failed an anti-TNF drug due to inefficacy and 452 patients who previously failed a conventional DMARD for whom smoking data were available. Sixty percent of the database cohort were ever-smokers whereas the remaining 40% never smoked tobacco. It has recently been proposed1 that exposure to tobacco smoke reduced the efficacy of anti-TNF therapy in patients with rheumatoid arthritis (RA). Mattey, et al noted higher Disease Activity Scores (DAS) in ever-smokers compared with never-smokers despite the …
Address correspondence to Dr. Harty; E-mail: lenharty{at}yahoo.com