{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T06:13:54Z","timestamp":1787724834735,"version":"build-2784847793"},"reference-count":32,"publisher":"The Journal of Rheumatology","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Rheumatol"],"published-print":{"date-parts":[[2019,4]]},"abstract":"<jats:sec>\n                    <jats:title>Objective.<\/jats:title>\n                    <jats:p>Prior studies around the relationship between smoking and rheumatoid arthritis (RA) disease activity have reported inconsistent findings, which may be ascribed to heterogeneous study designs or biases in statistical analyses. We examined the association between smoking and RA outcomes using statistical methods that account for time-varying confounding and loss to followup.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods.<\/jats:title>\n                    <jats:p>We included 282 individuals with an RA diagnosis using electronic health record data collected at a public hospital between 2013 and 2017. Current smoking status and disease activity were assessed at each visit; covariates included sex, race\/ethnicity, age, obesity, and medication use. We used longitudinal targeted maximum likelihood estimation to estimate the causal effect of smoking on disease activity measures at 27 months, and compared results to conventional longitudinal methods.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results.<\/jats:title>\n                    <jats:p>Smoking was associated with an increase of 0.64 units in the patient global score compared to nonsmoking (p = 0.01), and with 2.58 more swollen joints (p &lt; 0.001). While smoking was associated with a higher clinical disease activity score (2.11), the difference was not statistically significant (p = 0.22). We found no association between smoking and physician global score, or C-reactive protein levels, and an inverse association between smoking and tender joint count (p = 0.05). Analyses using conventional methods showed a null relationship for all outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion.<\/jats:title>\n                    <jats:p>Smoking is associated with higher levels of disease activity in RA. Causal methods may be useful for investigations of additional exposures on longitudinal outcome measures in rheumatologic disease.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3899\/jrheum.180262","type":"journal-article","created":{"date-parts":[[2018,12,1]],"date-time":"2018-12-01T12:25:12Z","timestamp":1543667112000},"page":"370-375","source":"Crossref","is-referenced-by-count":33,"title":["Smoking Is Associated with Higher Disease Activity in Rheumatoid Arthritis: A Longitudinal Study Controlling for Time-varying Covariates"],"prefix":"10.3899","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8351-4626","authenticated-orcid":false,"given":"Milena A.","family":"Gianfrancesco","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4046-200X","authenticated-orcid":false,"given":"Laura","family":"Trupin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9257-2609","authenticated-orcid":false,"given":"Stephen","family":"Shiboski","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"van der Laan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Graf","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Imboden","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3508-4094","authenticated-orcid":false,"given":"Jinoos","family":"Yazdany","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2687-5043","authenticated-orcid":false,"given":"Gabriela","family":"Schmajuk","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2262","published-online":{"date-parts":[[2018,12,1]]},"reference":[{"key":"2019040109152888000_46.4.370.1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-93-4-551"},{"key":"2019040109152888000_46.4.370.2","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2008.096487"},{"key":"2019040109152888000_46.4.370.3","first-page":"630","article-title":"The effect of smoking on clinical, laboratory, and radiographic status in rheumatoid arthritis","volume":"27","author":"Wolfe","year":"2000","journal-title":"J Rheumatol"},{"key":"2019040109152888000_46.4.370.4","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2007.082669"},{"key":"2019040109152888000_46.4.370.5","first-page":"2313","article-title":"Nodular disease in rheumatoid arthritis: association with cigarette smoking and HLA-DRB1\/TNF gene interaction","volume":"29","author":"Mattey","year":"2002","journal-title":"J Rheumatol"},{"key":"2019040109152888000_46.4.370.6","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/39.11.1202"},{"key":"2019040109152888000_46.4.370.7","doi-asserted-by":"publisher","DOI":"10.1002\/1529-0131(200102)44:2<323::AID-ANR49>3.0.CO;2-C"},{"key":"2019040109152888000_46.4.370.8","first-page":"861","article-title":"Does cigarette smoking influence disease expression, activity and severity in early rheumatoid arthritis patients?","volume":"23","author":"Papadopoulos","year":"2005","journal-title":"Clin Exp Rheumatol"},{"key":"2019040109152888000_46.4.370.9","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/kei240"},{"key":"2019040109152888000_46.4.370.10","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2006.065060"},{"key":"2019040109152888000_46.4.370.11","doi-asserted-by":"publisher","DOI":"10.1097\/00001648-200009000-00011"},{"key":"2019040109152888000_46.4.370.12","doi-asserted-by":"crossref","unstructured":"Robins JM . Analytic methods for estimating HIV treatment and cofactor effects. In: Ostrow DG Kessler RC , editors. Methodological issues of AIDS mental health research. New York: Plenum Publishing; 1993:213\u201390.","DOI":"10.1007\/0-306-47137-X_12"},{"key":"2019040109152888000_46.4.370.13","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1515\/jci-2013-0007","article-title":"Targeted maximum likelihood estimation for dynamic and static longitudinal marginal structural working models","volume":"2","author":"Petersen","year":"2014","journal-title":"J Causal Inference"},{"key":"2019040109152888000_46.4.370.14","doi-asserted-by":"publisher","DOI":"10.1186\/ar1740"},{"key":"2019040109152888000_46.4.370.15","doi-asserted-by":"crossref","unstructured":"Robins JM . Marginal structural models versus structural nested models as tools for causal inference. In: Statistical models in epidemiology, the environment, and clinical trials. New York: Springer; 2000:95\u2013133.","DOI":"10.1007\/978-1-4612-1284-3_2"},{"key":"2019040109152888000_46.4.370.16","doi-asserted-by":"publisher","DOI":"10.1111\/j.1742-7843.2006.pto_329.x"},{"key":"2019040109152888000_46.4.370.17","doi-asserted-by":"publisher","DOI":"10.1177\/0962280210386207"},{"key":"2019040109152888000_46.4.370.18","doi-asserted-by":"crossref","unstructured":"van der Laan MJ Gruber S . Targeted minimum loss based estimation of causal effects of multiple time point interventions. Int J Biostat 2012;8.","DOI":"10.1515\/1557-4679.1370"},{"key":"2019040109152888000_46.4.370.19","unstructured":"Schwab J Lendle S Petersen M van der Laan M , editors. Ltmle: Longitudinal targeted maximum likelihood estimation. R package version 0.9.3-1. [Internet. Accessed October 18, 2018.] Available from: CRAN.R-project.org\/package=ltmle"},{"key":"2019040109152888000_46.4.370.20","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwf215"},{"key":"2019040109152888000_46.4.370.21","doi-asserted-by":"publisher","DOI":"10.1136\/ard.56.8.463"},{"issue":"Suppl 2","key":"2019040109152888000_46.4.370.22","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1136\/annrheumdis-2014-eular.3765","article-title":"Cigarette smoking and disease activity in rheumatoid arthritis patients: Results from Ontario Best Practice Research Initiative (OBRI)","volume":"72","author":"Jacob","year":"2014","journal-title":"Ann Rheum Dis"},{"key":"2019040109152888000_46.4.370.23","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.110852"},{"key":"2019040109152888000_46.4.370.24","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/ken057"},{"key":"2019040109152888000_46.4.370.25","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.130074"},{"key":"2019040109152888000_46.4.370.26","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1177\/002204261004000112","article-title":"A marginal structural modeling approach to assess the cumulative effect of drug treatment on the later drug use abstinence","volume":"40","author":"Li","year":"2010","journal-title":"J Drug Issues"},{"key":"2019040109152888000_46.4.370.27","doi-asserted-by":"publisher","DOI":"10.1097\/EDE.0b013e31821d0507"},{"key":"2019040109152888000_46.4.370.28","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2016-210283"},{"key":"2019040109152888000_46.4.370.29","doi-asserted-by":"publisher","DOI":"10.1016\/j.ypmed.2005.02.002"},{"key":"2019040109152888000_46.4.370.30","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1186\/1758-5996-6-79","article-title":"Cigarette smoking worsens systemic inflammation in persons with metabolic syndrome","volume":"6","author":"Jamal","year":"2014","journal-title":"Diabetol Metab Syndr"},{"key":"2019040109152888000_46.4.370.31","doi-asserted-by":"crossref","first-page":"439396","DOI":"10.1155\/2015\/439396","article-title":"Smoking status effect on inflammatory markers in a randomized trial of current and former heavy smokers","volume":"2015","author":"Aldaham","year":"2015","journal-title":"Int J Inflam"},{"key":"2019040109152888000_46.4.370.32","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0006242"}],"container-title":["The Journal of Rheumatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.3899\/jrheum.180262","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,4]],"date-time":"2026-04-04T07:54:42Z","timestamp":1775289282000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.jrheum.org\/lookup\/doi\/10.3899\/jrheum.180262"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,12,1]]},"references-count":32,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2019,4,1]]},"published-print":{"date-parts":[[2019,4]]}},"alternative-id":["10.3899\/jrheum.180262"],"URL":"https:\/\/doi.org\/10.3899\/jrheum.180262","relation":{},"ISSN":["0315-162X","1499-2752"],"issn-type":[{"value":"0315-162X","type":"print"},{"value":"1499-2752","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,12,1]]}}}