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The Effect of Snuff (Smokeless Tobacco) on Disease Activity and Function in Rheumatoid Arthritis: Experiences From the Better Anti-Rheumatic FarmacOTherapy, a Longitudinal Multicenter Study on Early Rheumatoid Arthritis

Andersson, Maria L.E. PhD*; Bergman, Stefan MD, PhD; Söderlin, Maria K. MD, PhD*‡for the BARFOT study group

JCR: Journal of Clinical Rheumatology: January 2013 - Volume 19 - Issue 1 - p 14–18
doi: 10.1097/RHU.0b013e31828214ed
Original Articles

Background It is not known whether snuff (moist smokeless tobacco) affects disease activity in rheumatoid arthritis (RA).

Objective This study aims to study the effect of snuff on disease activity and function in Swedish patients with early RA.

Methods Between 1992 and 2005, 2800 adult patients were included in the Better Anti-Rheumatic FarmacOTherapy (BARFOT) early RA study in Sweden. Disease Activity Score 28 joints (DAS28), Health Assessment Questionnaire, visual analog scale for general health, and drug treatment were registered at inclusion and at follow-up after 1, 2, and 5 years. European League Against Rheumatism response and remission criteria were applied at 1 year. In 2010, a self-completed postal questionnaire was sent to 2102 patients in the BARFOT study enquiring about lifestyle factors such as smoking and use of snuff. Three controls for each patient using snuff were identified.

Results Fifty-one patients who used snuff were identified, together with 145 controls. When we adjusted for socioeconomic class, disease duration, and previous antirheumatic medication, the snuff users had lower DAS28 values at up to 6 months of follow-up than patients who had never smoked, and they had lower DAS28 values than previous smokers at up to 2 years of follow-up. No effect of snuff use on European League Against Rheumatism response was seen at up to 1 year.

Conclusions Snuff users initially had lower DAS28 levels than never smokers and previous smokers.

From the *Research and Development Center, Spenshult Rheumatology Hospital, Oskarström; †Department of Rheumatology, IKVL, Lund University, Lund; and ‡Research and Development Center, Spenshult Rheumatology Hospital, Oskarström, Sweden.

Members of the Better Anti-Rheumatic FarmacOTherapy study group: Sofia Ajeganova, Maria Andersson, Valentina Bala, Stefan Bergman, Kristina Forslind, Ingiäld Hafström, Catharina Keller, Ido Leden, Bengt Lindell, Ingemar Petersson, Christoffer Schaufelberger, Björn Svensson, Maria Söderlin, Annika Teleman, Jan Theander, and Anneli Östenson.

Funding: This study was supported by grants from the Swedish Society of Medicine, the Swedish Rheumatism Association, the Research Department of the County Council of Halland, the Gothenburg District Rheumatology Foundation, and the Crafoord Foundation.

Conflicts of interest: Dr Maria. K. Söderlin has received speaking fees for educational events from Abbott (<$3,000), MSD (<$1,000), and speaking fees and consultation fees from Pfizer (<$10,000). Dr Stefan Bergman has received fees from speakers bureau from Pfizer (<$5000).

Correspondence: Maria K. Söderlin, MD, PhD, Research and Development Center, Spenshult Rheumatology Hospital, SE-313 92, Oskarström, Sweden. E-mail:

© 2013 Lippincott Williams & Wilkins, Inc.