A recent study conducted by researchers from the University of Toronto reveals that smoking—whether current or past—does not significantly influence radiographic progression in patients with psoriatic arthritis (PsA), a form of inflammatory arthritis linked to psoriasis. This discovery presents a paradox, as smoking has been shown to contribute to radiographic damage in other conditions like rheumatoid arthritis and axial spondyloarthritis.
Lead author Dr. Fadi Kharouf and his colleagues noted that while smoking is known to have numerous detrimental effects on health, it does not appear to play a major role in the progression of joint damage in PsA, as seen in other autoimmune diseases. The study, published on February 5 in Seminars in Arthritis and Rheumatism, challenges existing assumptions regarding the impact of smoking on PsA.
PsA affects peripheral joints and the axial skeleton, with a prevalence rate ranging from 0.3% to 1% in the general population, and up to 24% in those with psoriasis. Smoking has been linked to an increased risk of conditions such as rheumatoid arthritis, Crohn’s disease, and systemic lupus erythematosus, yet its role in PsA remains unclear.
This study is the first to examine the relationship between smoking and radiographic damage in PsA patients, according to the researchers. The research team conducted the study at the Gladman Krembil Psoriatic Arthritis Research Program, where data was collected from patients between 1978 and 2024. The study analyzed the effects of smoking on joint damage, assessed via X-rays using the modified Steinbrocker method, which measures joint deterioration on a scale from 0 to 4.
Of the 1,736 PsA patients included in the analysis, 906 (52.2%) were nonsmokers, 211 (12.2%) were former smokers, and 311 (17.9%) were current smokers. The remaining 308 (17.7%) had missing data regarding their smoking status. At the study’s baseline, participants had an average psoriasis duration of 15.9 years and PsA duration of 6.3 years.
The results indicated that while longer durations between initial and subsequent radiographs, higher baseline Steinbrocker scores, and the use of conventional disease-modifying antirheumatic drugs (DMARDs) were linked to increased joint damage, smoking did not show any significant association with changes in joint deterioration.
Despite evidence suggesting that ever-smokers report worse global health, increased pain, and fatigue compared to non-smokers, the study suggests that smoking does not accelerate joint damage in PsA patients. This phenomenon, referred to as the “smoking paradox,” indicates that while smoking may increase the risk of developing PsA, it does not seem to exacerbate its radiographic progression.
The researchers concluded that additional studies are needed to further explore these findings and provide a clearer understanding of the relationship between smoking and PsA.
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