https://doi.org/10.4081/reumatismo.2024.1572
The impact of nicotine smoking on spondyloarthritis and rheumatoid arthritis
Submitted: 2 March 2023
Accepted: 18 March 2024
Published: 24 June 2024
Accepted: 18 March 2024
Abstract Views: 2668
PDF: 1061
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
Objective. Nicotine has major side effects on human health through numerous mechanisms, one of which is the alteration of the immune system and its genetic components. Such alteration can be a predisposing factor for autoimmune diseases such as spondyloarthritis (SpA) and rheumatoid arthritis (RA). This review aims to shed light on the effects of nicotine smoking on the pathophysiology, clinical presentation, and management of SpA and RA.
Methods. This review looked into the studies, excluding case reports and series, which were cited by PubMed/MEDLINE.
Results. Patients with established autoimmune conditions may have a different underlying pathophysiology and disease course when exposed to nicotine through cigarette smoking. Through the involvement of several cytokines, endothelial dysfunction, and epigenetic mechanisms, the severity of SpA is more prominent in smokers. The global health status, pain, and fatigue are worse in SpA patients. The evidence on the effect of nicotine smoking on the treatment of SpA is still limited. Nicotine can contribute to RA via the disruption of cellular regulatory activity, inflammatory responses, morphological, physiological, biochemical, and enzymatic responses. As such, smokers with RA have higher disease activity and are more likely to be seropositive through the citrullination of peptides. In addition, these patients are at risk of achieving a suboptimal response to tumor necrosis factor inhibitors.
Conclusions. Cigarette smoking can substantially affect the pathophysiology and clinical presentation of patients with SpA and RA. The impact of nicotine on the management of these diseases still needs to be further studied.
Marom-Haham L, Shulman A. Cigarette smoking and hormones. Current Opin Obstet Gynecol 2016; 28: 230-5.
DOI: https://doi.org/10.1097/GCO.0000000000000283
Prochaska JJ, Benowitz NL. Current advances in research in treatment and recovery: nicotine addiction. Sci Adv 2019; 5: eaay9763.
DOI: https://doi.org/10.1126/sciadv.aay9763
Yu H, Yang YH, Rajaiah R, Moudgil KD. Nicotine-induced differential modulation of autoimmune arthritis in the Lewis rat involves changes in interleukin-17 and anti-cyclic citrullinated peptide antibodies. Arthritis Rheum 2011; 63: 981-91.
DOI: https://doi.org/10.1002/art.30219
Geng Y, Savage SM, Johnson LJ, Seagrave J, Sopori ML. Effects of nicotine on the immune response. I. Chronic exposure to nicotine impairs antigen receptor-mediated signal transduction in lymphocytes. Toxicol Appl Pharmacol 1995; 135: 268-78.
DOI: https://doi.org/10.1006/taap.1995.1233
Alexandrov LB, Ju YS, Haase K, Van Loo P, Martincorena I, Nik-Zainal S, et al. Mutational signatures associated with tobacco smoking in human cancer. Science 2016; 354: 618-22.
DOI: https://doi.org/10.1126/science.aag0299
Al-Bogami M, Alkhorayef MA, Akanle OA, Jawad A, Mageed R. The effects of smoking on response of osteoporosis treatment using dual energy X-ray absorptiometry scans, invited. Transactions of the American Nuclear Society 2013; 109: 51-2.
Mueck AO, Seeger H. Smoking, estradiol metabolism and hormone replacement therapy. Current Med Chem Cardiovasc Hematol Agents 2005; 3: 45-54.
DOI: https://doi.org/10.2174/1568016052773270
Madej M, Nowak B, Świerkot J, Sokolik R, Chlebicki A, Korman L, et al. Cytokine profiles in axial spondyloarthritis. Reumatologia 2015; 53: 9-13.
DOI: https://doi.org/10.5114/reum.2015.50551
Wendling D, Guillot X, Prati C. The IL-23/Th 17 pathway in spondyloarthritis: the royal road?. Joint Bone Spine 2015; 82: 1-4.
DOI: https://doi.org/10.1016/j.jbspin.2014.08.003
Schinocca C, Rizzo C, Fasano S, Grasso G, La Barbera L, Ciccia F, et al. Role of the IL-23/IL-17 pathway in rheumatic diseases: an overview. Front Immunol 2021; 12: 637829.
DOI: https://doi.org/10.3389/fimmu.2021.637829
Berthelot JM, Le Goff B. Rheumatoid arthritis and periodontal disease. Joint Bone Spine 2010; 77: 537-41.
DOI: https://doi.org/10.1016/j.jbspin.2010.04.015
Bodnár N, Szekanecz Z, Prohászka Z, Kemény-Beke A, Némethné-Gyurcsik Z, Gulyás K, et al. Anti-mutated citrullinated vimentin (anti-MCV) and anti-65 kDa heat shock protein (anti-hsp65): new biomarkers in ankylosing spondylitis. Joint Bone Spine 2012; 79: 63-6.
DOI: https://doi.org/10.1016/j.jbspin.2011.03.010
Bay-Jensen AC, Karsdal MA, Vassiliadis E, Wichuk S, Marcher-Mikkelsen K, Lories R, et al. Circulating citrullinated vimentin fragments reflect disease burden in ankylosing spondylitis and have prognostic capacity for radiographic progression. Arthritis Rheum 2013; 65: 972-80.
DOI: https://doi.org/10.1002/art.37843
Wendling D, Vuitton L, Koch S, Prati C. Spondyloarthritis and the gut: a new look. Joint Bone Spine 2015; 82: 77-9.
DOI: https://doi.org/10.1016/j.jbspin.2014.12.004
Biedermann L, Brülisauer K, Zeitz J, Frei P, Scharl M, Vavricka SR, et al. Smoking cessation alters intestinal microbiota: insights from quantitative investigations on human fecal samples using FISH. Inflamm Bowel Dis 2014; 20: 1496-501.
DOI: https://doi.org/10.1097/MIB.0000000000000129
Schaeverbeke T, Truchetet ME, Richez C. Gut metagenome and spondyloarthritis. Joint Bone Spine 2013; 80: 349-52.
DOI: https://doi.org/10.1016/j.jbspin.2013.02.005
Quaglio AEV, Grillo TG, De Oliveira ECS, Di Stasi LC, Sassaki LY. Gut microbiota, inflammatory bowel disease and colorectal cancer. World J Gastroenterol 2022; 28: 4053-60.
DOI: https://doi.org/10.3748/wjg.v28.i30.4053
Ananthakrishnan AN. Epidemiology and risk factors for IBD. Nat Rev Gastroenterol Hepatol 2015; 12: 205-17.
DOI: https://doi.org/10.1038/nrgastro.2015.34
Prati C, Demougeot C, Guillot X, Godfrin-Valnet M, Wendling D. Endothelial dysfunction in joint disease. Joint Bone Spine 2014; 81: 386-91.
DOI: https://doi.org/10.1016/j.jbspin.2014.01.014
Poddubnyy D, Conrad K, Haibel H, Syrbe U, Appel H, Braun J, et al. Elevated serum level of the vascular endothelial growth factor predicts radiographic spinal progression in patients with axial spondyloarthritis. Ann Rheum Dis 2014; 73: 2137-43.
DOI: https://doi.org/10.1136/annrheumdis-2013-203824
Miyata S, Noda A, Ito Y, Iizuka R, Shimokata K. Smoking acutely impaired endothelial function in healthy college students. Acta Cardiol 2015; 70: 282-5.
DOI: https://doi.org/10.1080/AC.70.3.3080632
Fujita Y, Yamashita T. Sirtuins in neuroendocrine regulation and neurological diseases. Front Neurosci 2018; 12: 778.
DOI: https://doi.org/10.3389/fnins.2018.00778
Wendling D, Prati C. Smoking and spondyloarthritis: a bad connection. Rheumatol Int 2015; 35: 1951-3.
DOI: https://doi.org/10.1007/s00296-015-3368-0
Arunachalam G, Yao H, Sundar IK, Caito S, Rahman I. SIRT1 regulates oxidant- and cigarette smoke-induced eNOS acetylation in endothelial cells: role of resveratrol. Biochem Biophys Res Commun 2010; 393: 66-72.
DOI: https://doi.org/10.1016/j.bbrc.2010.01.080
Nguyen UDT, Zhang Y, Lu N, Louie-Gao Q, Niu J, Ogdie A, et al. Smoking paradox in the development of psoriatic arthritis among patients with psoriasis: a population-based study. Ann Rheum Dis 2018; 77: 119-23.
DOI: https://doi.org/10.1136/annrheumdis-2017-211625
Videm V, Cortes A, Thomas R, Brown MA. Current smoking is associated with incident ankylosing spondylitis -- the HUNT population-based Norwegian health study. J Rheumatol 2014; 41: 2041-8.
DOI: https://doi.org/10.3899/jrheum.140353
Zhao S, Challoner B, Khattak M, Moots RJ, Goodson NJ. Increasing smoking intensity is associated with increased disease activity in axial spondyloarthritis. Rheumatol Int 2017; 37: 239-44.
DOI: https://doi.org/10.1007/s00296-016-3590-4
Zhao S, Jones GT, Macfarlane GJ, Hughes DM, Dean LE, Moots RJ, et al. Associations between smoking and extra-axial manifestations and disease severity in axial spondyloarthritis: results from the BSR Biologics Register for Ankylosing Spondylitis (BSRBR-AS). Rheumatology (Oxford) 2019; 58: 811-9.
DOI: https://doi.org/10.1093/rheumatology/key371
Ciurea A, Finckh A. Smoking and spondyloarthritis. Joint Bone Spine 2013; 80: 234-5.
DOI: https://doi.org/10.1016/j.jbspin.2012.10.017
Poddubnyy D, Haibel H, Listing J, Märker-Hermann E, Zeidler H, Braun J, et al. Baseline radiographic damage, elevated acute-phase reactant levels, and cigarette smoking status predict spinal radiographic progression in early axial spondylarthritis. Arthritis Rheum 2012; 64: 1388-98.
DOI: https://doi.org/10.1002/art.33465
Zhao SS, Goodson NJ, Robertson S, Gaffney K. Smoking in spondyloarthritis: unravelling the complexities. Rheumatology (Oxford) 2020; 59: 1472-81.
DOI: https://doi.org/10.1093/rheumatology/keaa093
Braun J, Baraliakos X, Hermann KG, Xu S, Hsu B. Serum C-reactive protein levels demonstrate predictive value for radiographic and magnetic resonance imaging outcomes in patients with active ankylosing spondylitis treated with golimumab. J Rheumatol 2016; 43: 1704-12.
DOI: https://doi.org/10.3899/jrheum.160003
Kim HR, Hong YS, Park SH, Ju JH, Kang KY. Low bone mineral density predicts the formation of new syndesmophytes in patients with axial spondyloarthritis. Arthritis Res Ther 2018; 20:231.
DOI: https://doi.org/10.1186/s13075-018-1731-8
Min HK, Lee J, Ju JH, Park SH, Kwok SK. Alcohol consumption as a predictor of the progression of spinal structural damage in axial spondyloarthritis: data from the Catholic Axial Spondyloarthritis COhort (CASCO). Arthritis Res Ther 2019; 21: 187.
DOI: https://doi.org/10.1186/s13075-019-1970-3
Bremander A, Jacobsson LT, Bergman S, Haglund E, Löfvendahl S, Petersson IF. Smoking is associated with a worse self-reported health status in patients with psoriatic arthritis: data from a Swedish population-based cohort. Clin Rheumatol 2015; 34: 579-83.
DOI: https://doi.org/10.1007/s10067-014-2742-8
Villaverde-García V, Cobo-Ibáñez T, Candelas-Rodríguez G, Seoane-Mato D, Campo-Fontecha PDD, Guerra M, et al. The effect of smoking on clinical and structural damage in patients with axial spondyloarthritis: a systematic literature review. Semin Arthritis Rheum 2017; 46: 569-83.
DOI: https://doi.org/10.1016/j.semarthrit.2016.11.004
Ciurea A, Scherer A, Weber U, Exer P, Bernhard J, Tamborrini G, et al. Impaired response to treatment with tumour necrosis factor α inhibitors in smokers with axial spondyloarthritis. Ann Rheum Dis 2016; 75: 532-9.
DOI: https://doi.org/10.1136/annrheumdis-2013-205133
Zurita Prada PA, Urrego Laurín CL, Guillén Astete CA, Kanaffo Caltelblanco S, Navarro-Compán V. Influence of smoking and obesity on treatment response in patients with axial spondyloarthritis: a systematic literature review. Clin Rheumatol 2021; 40: 1673-86.
DOI: https://doi.org/10.1007/s10067-020-05319-6
Pezzolo E, Naldi L. The relationship between smoking, psoriasis and psoriatic arthritis. Expert Rev Clin Immunol 2019; 15: 41-8.
DOI: https://doi.org/10.1080/1744666X.2019.1543591
Højgaard P, Glintborg B, Hetland ML, Hansen TH, Lage-Hansen PR, Petersen MH, et al. Association between tobacco smoking and response to tumour necrosis factor α inhibitor treatment in psoriatic arthritis: results from the DANBIO registry. Ann Rheum Dis 2015; 74: 2130-6.
DOI: https://doi.org/10.1136/annrheumdis-2014-205389
Haddad A, Gazitt T, Feldhamer I, Feld J, Cohen AD, Lavi I, et al. Treatment persistence of biologics among patients with psoriatic arthritis. Arthritis Res Ther 2021; 23: 44.
DOI: https://doi.org/10.1186/s13075-021-02417-x
Riechers E, Kiltz U, Brandt-Juergens J, Kästner P, Peterlik D, Tony HP. Does smoking affect secukinumab treatment outcomes and safety in patients with psoriatic arthritis? - Real world data from the German Aquila study. Ann Rheum Dis 2020; 79: 1711.
DOI: https://doi.org/10.1136/annrheumdis-2020-eular.365
Scott DL, Wolfe F, Huizinga TW. Rheumatoid arthritis. Lancet 2010; 376: 1094-108.
DOI: https://doi.org/10.1016/S0140-6736(10)60826-4
Chang K, Yang SM, Kim SH, Han KH, Park SJ, Shin JI. Smoking and rheumatoid arthritis. Int J Mol Sci 2014; 15: 22279-95.
DOI: https://doi.org/10.3390/ijms151222279
Sugiyama D, Nishimura K, Tamaki K, Tsuji G, Nakazawa T, Morinobu A, et al. Impact of smoking as a risk factor for developing rheumatoid arthritis: a meta-analysis of observational studies. Ann Rheum Dis 2010; 69: 70-81.
DOI: https://doi.org/10.1136/ard.2008.096487
Pryor WA, Stone K. Oxidants in cigarette smoke. Radicals, hydrogen peroxide, peroxynitrate, and peroxynitrite. Ann N Y Acad Sci 1993; 686: 12-27; discussion 27-8.
DOI: https://doi.org/10.1111/j.1749-6632.1993.tb39148.x
Sopori M. Effects of cigarette smoke on the immune system. Nat Rev Immunol 2002; 2: 372-7.
DOI: https://doi.org/10.1038/nri803
Bracke K, Cataldo D, Maes T, Gueders M, Noël A, Foidart JM, et al. Matrix metalloproteinase-12 and cathepsin D expression in pulmonary macrophages and dendritic cells of cigarette smoke-exposed mice. Int Arch Allergy Immunol 2005; 138: 169-79.
DOI: https://doi.org/10.1159/000088439
Raitio A, Tuomas H, Kokkonen N, Salo T, Sorsa T, Hanemaaijer R, et al. Levels of matrix metalloproteinase-2, -9 and -8 in the skin, serum and saliva of smokers and non-smokers. Arch Dermatol Res 2005; 297: 242-8.
DOI: https://doi.org/10.1007/s00403-005-0597-1
Shegarfi H, Naddafi F, Mirshafiey A. Natural killer cells and their role in rheumatoid arthritis: friend or foe?. ScientificWorldJournal 2012; 2012: 491974.
DOI: https://doi.org/10.1100/2012/491974
Wegner N, Lundberg K, Kinloch A, Fisher B, Malmström V, Feldmann M, et al. Autoimmunity to specific citrullinated proteins gives the first clues to the etiology of rheumatoid arthritis. Immunol Rev 2010; 233: 34-54.
DOI: https://doi.org/10.1111/j.0105-2896.2009.00850.x
Bang SY, Lee KH, Cho SK, Lee HS, Lee KW, Bae SC. Smoking increases rheumatoid arthritis susceptibility in individuals carrying the HLA-DRB1 shared epitope, regardless of rheumatoid factor or anti-cyclic citrullinated peptide antibody status. Arthritis Rheum 2010; 62: 369-77.
DOI: https://doi.org/10.1002/art.27272
Klareskog L, Stolt P, Lundberg K, Källberg H, Bengtsson C, Grunewald J, et al. A new model for an etiology of rheumatoid arthritis: smoking may trigger HLA-DR (shared epitope)-restricted immune reactions to autoantigens modified by citrullination. Arthritis Rheum 2006; 54: 38-46.
DOI: https://doi.org/10.1002/art.21575
Hitchon CA, Chandad F, Ferucci ED, Willemze A, Ioan-Facsinay A, van der Woude D, et al. Antibodies to porphyromonas gingivalis are associated with anticitrullinated protein antibodies in patients with rheumatoid arthritis and their relatives. J Rheumatol 2010; 37: 1105-12.
DOI: https://doi.org/10.3899/jrheum.091323
Fisher BA, Cartwright AJ, Quirke AM, de Pablo P, Romaguera D, Panico S, et al. Smoking, Porphyromonas gingivalis and the immune response to citrullinated autoantigens before the clinical onset of rheumatoid arthritis in a Southern European nested case-control study. BMC Musculoskelet Disord 2015; 16: 331. Erratum in: BMC Musculoskelet Disord 2016; 17: 62.
DOI: https://doi.org/10.1186/s12891-015-0792-y
Scher JU, Ubeda C, Equinda M, Khanin R, Buischi Y, Viale A, et al. Periodontal disease and the oral microbiota in new-onset rheumatoid arthritis. Arthritis Rheum 2012; 64: 3083-94.
DOI: https://doi.org/10.1002/art.34539
Gudelj Gracanin A, Markovic I, Golob M, Lucijanic M, Valetic AM, Morovic-Vergles J. The effect of smoking on disease activity in rheumatoid arthritis - our experience. Acta Clin Croat 2020; 59: 312-7.
DOI: https://doi.org/10.20471/acc.2020.59.02.15
Vesperini V, Lukas C, Fautrel B, Le Loet X, Rincheval N, Combe B. Association of tobacco exposure and reduction of radiographic progression in early rheumatoid arthritis: results from a French multicenter cohort. Arthritis Care Res (Hoboken) 2013; 65: 1899-906.
DOI: https://doi.org/10.1002/acr.22057
Söderlin MK, Petersson IF, Bergman S, Svensson B. Smoking at onset of rheumatoid arthritis (RA) and its effect on disease activity and functional status: experiences from BARFOT, a long-term observational study on early RA. Scand J Rheumatol 2011; 40: 249-55.
DOI: https://doi.org/10.3109/03009742.2010.541495
Turesson C, Jacobsson LT. Epidemiology of extra-articular manifestations in rheumatoid arthritis. Scand J Rheumatol 2004; 33: 65-72.
DOI: https://doi.org/10.1080/03009740310004621
Turesson C, O’Fallon WM, Crowson CS, Gabriel SE, Matteson EL. Extra-articular disease manifestations in rheumatoid arthritis: incidence trends and risk factors over 46 years. Ann Rheum Dis 2003; 62: 722-7.
DOI: https://doi.org/10.1136/ard.62.8.722
Kim SK, Park SH, Shin IH, Choe JY. Anti-cyclic citrullinated peptide antibody, smoking, alcohol consumption, and disease duration as risk factors for extraarticular manifestations in Korean patients with rheumatoid arthritis. J Rheumatol 2008; 35: 995-1001.
Qiu M, Jiang J, Nian X, Wang Y, Yu P, Song J, et al. Factors associated with mortality in rheumatoid arthritis-associated interstitial lung disease: a systematic review and meta-analysis. Respir Res 2021; 22: 264.
DOI: https://doi.org/10.1186/s12931-021-01856-z
Nyhäll-Wåhlin BM, Petersson IF, Nilsson JA, Jacobsson LT, Turesson C. High disease activity disability burden and smoking predict severe extra-articular manifestations in early rheumatoid arthritis. Rheumatology (Oxford) 2009; 48: 416-20.
DOI: https://doi.org/10.1093/rheumatology/kep004
Popescu D, Rezus E, Badescu MC, Dima N, Seritean Isac PN, Dragoi IT, et al. Cardiovascular risk assessment in rheumatoid arthritis: accelerated atherosclerosis, new biomarkers, and the effects of biological therapy. Life (Basel) 2023; 13: 319.
DOI: https://doi.org/10.3390/life13020319
Hyrich KL, Watson KD, Silman AJ, Symmons DP. Predictors of response to anti-TNF-alpha therapy among patients with rheumatoid arthritis: results from the British Society for Rheumatology Biologics Register. Rheumatology (Oxford) 2006; 45: 1558-65.
DOI: https://doi.org/10.1093/rheumatology/kel149
Mattey DL, Brownfield A, Dawes PT. Relationship between pack-year history of smoking and response to tumor necrosis factor antagonists in patients with rheumatoid arthritis. J Rheumatol 2009; 36: 1180-7.
DOI: https://doi.org/10.3899/jrheum.081096
Abhishek A, Butt S, Gadsby K, Zhang W, Deighton CM. Anti-TNF-alpha agents are less effective for the treatment of rheumatoid arthritis in current smokers. J Clin Rheumatol 2010; 16: 15-8.
DOI: https://doi.org/10.1097/RHU.0b013e3181ca4a2a
Bobbio-Pallavicini F, Caporali R, Alpini C, Avalle S, Epis OM, Klersy C, et al. High IgA rheumatoid factor levels are associated with poor clinical response to tumour necrosis factor alpha inhibitors in rheumatoid arthritis. Ann Rheum Dis 2007; 66: 302-7.
DOI: https://doi.org/10.1136/ard.2006.060608
Braun-Moscovici Y, Markovits D, Zinder O, Schapira D, Rozin A, Ehrenburg M, et al. Anti-cyclic citrullinated protein antibodies as a predictor of response to anti-tumor necrosis factor-alpha therapy in patients with rheumatoid arthritis. J Rheumatol 2006; 33: 497-500.
Glossop JR, Dawes PT, Mattey DL. Association between cigarette smoking and release of tumour necrosis factor alpha and its soluble receptors by peripheral blood mononuclear cells in patients with rheumatoid arthritis. Rheumatology (Oxford) 2006; 45: 1223-9.
DOI: https://doi.org/10.1093/rheumatology/kel094
Lorré K, Fransen L, Ceuppens JL. Interleukin-2 induces tumor necrosis factor-alpha production by activated human T cells via a cyclosporin-sensitive pathway. Eur Cytokine Netw 1992; 3: 321-30.
Park SJ, Shin JI. The effect of smoking on response and drug survival in rheumatoid arthritis patients treated with their first anti-TNF drug: comments on the article by Söderlin et al. Scand J Rheumatol 2012; 41: 411-2.
DOI: https://doi.org/10.3109/03009742.2012.698394
Metsios GS, Stavropoulos-Kalinoglou A, Nevill AM, Douglas KM, Koutedakis Y, Kitas GD. Cigarette smoking significantly increases basal metabolic rate in patients with rheumatoid arthritis. Ann Rheum Dis 2008; 67: 70-3.
DOI: https://doi.org/10.1136/ard.2006.068403
Siddiqui A, Totonchian A, Jabar Ali JB, Ahmad I, Kumar J, Shiwlani S, et al. Risk Factors associated with non-respondence to methotrexate in rheumatoid arthritis patients. Cureus 2021; 13: e18112.
DOI: https://doi.org/10.7759/cureus.18112
Leroux G, Costedoat-Chalumeau N, Hulot JS, Amoura Z, Francès C, Aymard G, et al. Relationship between blood hydroxychloroquine and desethylchloroquine concentrations and cigarette smoking in treated patients with connective tissue diseases. Ann Rheum Dis 2007; 66: 1547-8.
DOI: https://doi.org/10.1136/ard.2007.072587
How to Cite
El Hasbani, G., E Nassar, J., Elsayed Ali, A., Uthman, I., & Jawad, A. (2024). The impact of nicotine smoking on spondyloarthritis and rheumatoid arthritis. Reumatismo, 76(2). https://doi.org/10.4081/reumatismo.2024.1572
Copyright (c) 2024 the Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.
Similar Articles
- G. Valesini, F. Barone, D. Bompanone, M. Catuogno, A. Sili Scavalli, Advances in immunology and rheumatoid arthritis pathogenesis , Reumatismo: Vol. 56 No. s1 (2004)
- D. Marotto, M.E. Nieddu, A. Cossu, A. Carcassi, Prevalence of rheumatoid arthritis in North Sardinia: the Tempio Pausania’s study , Reumatismo: Vol. 57 No. 4 (2005)
- H. Parente, M. Pontes Ferreira, C. Soares, F. Guimarães, S. Azevedo, D. Santos-Faria, J. Tavares-Costa, D. Peixoto, C. Afonso, D. Roriz, F. Teixeira, Lumbosacral pain in a patient with psoriatic arthritis: when the rheumatic disease is innocent , Reumatismo: Vol. 75 No. 4 (2023)
- M. Filippini, G. Fontana, P. Bizioli, F. Crisafulli, R. Orabona, S. Zatti, F. Franceschini, A. Tincani, Pregnancy in patients affected by axial-spondyloarthritis: a narrative review of disease activity and obstetric outcomes , Reumatismo: Vol. 76 No. 3 (2024)
- C. Prete, F. Briano, C. Pizzorni, A. Sulli, M. Marcenaro, M. Cutolo, Stress response system and personality in rheumatoid arthritis patients , Reumatismo: Vol. 53 No. 3 (2001)
- F. Ingegnoli, N. Del Papa, E. Lupi, D.P. Comina, W. Maglione, V. Gerloni, F. Fantini, Anti-chromatin antibodies in juvenile rheumatoid arthritis , Reumatismo: Vol. 55 No. 4 (2003)
- P. Sarzi- Puttini, M. Antivalle, A. Marchesoni, E.G. Favalli, R. Gorla, M. Filippini, R. Caporali, F. Bobbio-Pallavicini, C. Montecucco, F. Atzeni, Efficacy and safety of anti-TNF agents in the Lombardy rheumatoid arthritis network (LORHEN) , Reumatismo: Vol. 60 No. 4 (2008)
- L. Degli Esposti, V. Perrone, D. Sangiorgi, L. Sinigaglia, Assessment of patients affected by rheumatoid arthritis eligible for biotechnological agents and evaluation of their healthcare resource utilization and related costs , Reumatismo: Vol. 73 No. 1 (2021)
- R. Scrivo, A. Spadaro, V. Riccieri, M. Bombardieri, M. Di Franco, D. Celestino, G. Valesini, Soluble P-selectin levels in synovial fluid and serum from patients with psoriatic arthritis , Reumatismo: Vol. 57 No. 4 (2005)
- S. Parisi, A. Bortoluzzi, G.D. Sebastiani, F. Conti, R. Caporali, N. Ughi, I. Prevete, A. Ariani, M. Manara, G. Carrara, C.A. Scirè, The Italian Society for Rheumatology clinical practice guidelines for rheumatoid arthritis , Reumatismo: Vol. 71 No. S1 (2019)
<< < 22 23 24 25 26 27 28 29 30 31 > >>
You may also start an advanced similarity search for this article.
