{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T15:17:28Z","timestamp":1785424648411,"version":"3.56.0"},"reference-count":40,"publisher":"AOSIS","issue":"1","license":[{"start":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T00:00:00Z","timestamp":1773878400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:p>Background:\u00a0People living with rheumatoid arthritis (RA) who smoke cigarettes are known to have worse outcomes with regard to disease control, extra-articular complications and comorbidities. Data regarding this from sub-Saharan Africa is lacking. This study aims to describe the prevalence of cigarette smoking and explore disease control, comorbidities and attitudes of smoking among RA patients in an outpatient clinic at a tertiary hospital.\nMethods:\u00a0A cross-sectional study of consenting adult outpatients with RA was conducted. Demographic, clinical and patient-reported outcome measures, together with a questionnaire about smoking and Fagerstr\u00f6m test for nicotine dependence, were collated.\nResults:\u00a0Of 632 patients (536 female participants), the mean (standard deviation) age and disease duration were 55.4 (13.0) and 10.1 (9.3) years, and 74.1% had two or more comorbidities. Of 218 (34.5%) smokers, more men smoked (p\u00a0= 0.0002). Compared to non-smokers, smokers had lower body mass index (p\u00a0= 0.01), higher incidence of chronic obstructive pulmonary disease (p\u00a0&lt; 0.005) and rheumatoid factor positivity (p\u00a0= 0.006), and higher anxiety scores (p\u00a0= 0.048) with more impairment in usual activities (p\u00a0= 0.05). No significant differences in disease activity, extra-articular disease, or in disability, fatigue, depression, or pain scores were observed. The most common reasons for smoking were emotional support (45.8%), nicotine craving (30.5%) and pain control (25.2%). The Fagerstr\u00f6m score revealed mild, moderate and severe nicotine dependence in 67.5%, 24.4%, and 7.5%, respectively.\nConclusion:\u00a0One in three patients with RA actively smoked. Those who smoked had more pain, anxiety, and depression but with low nicotine dependency scores.\nContribution:\u00a0The approach to tobacco cessation should occur in parallel with optimal pain, behavioural support and disease control.<\/jats:p>","DOI":"10.4102\/jcmsa.v4i1.350","type":"journal-article","created":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T08:23:08Z","timestamp":1773822188000},"update-policy":"https:\/\/doi.org\/10.4102\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Cigarette smoking habits and attitudes among rheumatoid arthritis patients at a tertiary centre in South Africa"],"prefix":"10.4102","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-0357-0930","authenticated-orcid":false,"given":"Simon J.","family":"le Roux","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/03p74gp79","id-type":"ROR","asserted-by":"publisher"}],"name":"University of Cape Town"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0745-1838","authenticated-orcid":false,"given":"Herman","family":"Bagula","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/03p74gp79","id-type":"ROR","asserted-by":"publisher"}],"name":"University of Cape Town"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4115-5362","authenticated-orcid":false,"given":"Richard","family":"van Zyl-Smit","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/03p74gp79","id-type":"ROR","asserted-by":"publisher"}],"name":"University of Cape Town"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5360-9483","authenticated-orcid":false,"given":"Bridget","family":"Hodkinson","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/03p74gp79","id-type":"ROR","asserted-by":"publisher"}],"name":"University of Cape Town"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2580","published-online":{"date-parts":[[2026,3,19]]},"reference":[{"key":"ref0","doi-asserted-by":"crossref","unstructured":"Sugiyama D, Nishimura K, Tamaki K, et al. Impact of smoking as a risk factor for developing rheumatoid arthritis: A meta-analysis of observational studies. Ann Rheum Dis. 2010;69(1):70\u201381. https:\/\/doi.org\/10.1136\/ard.2008.096487","DOI":"10.1136\/ard.2008.096487"},{"key":"ref1","doi-asserted-by":"crossref","unstructured":"Klareskog L, Stolt P, Lundberg K, 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(1):38\u201346. https:\/\/doi.org\/10.1002\/art.21575","DOI":"10.1002\/art.21575"},{"key":"ref2","doi-asserted-by":"crossref","unstructured":"Vittecoq O, Richard L, Banse C, Lequerre T. The impact of smoking on rheumatoid arthritis outcomes. Joint Bone Spine. 2018;85(2):135\u2013138. https:\/\/doi.org\/10.1016\/j.jbspin.2017.12.004","DOI":"10.1016\/j.jbspin.2017.12.004"},{"key":"ref3","doi-asserted-by":"crossref","unstructured":"Westhoff G, Rau R, Zink A. 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S Afr Med J. 2019;109(6):431\u2013436. https:\/\/doi.org\/10.7196\/SAMJ.2019.v109i6.13631","DOI":"10.7196\/SAMJ.2019.v109i6.13631"},{"key":"ref38","doi-asserted-by":"crossref","unstructured":"Lahiri M, Morgan C, Symmons DP, Bruce IN. Modifiable risk factors for RA: Prevention, better than cure? Rheumatology (Oxford). 2012;51(3):499\u2013512. https:\/\/doi.org\/10.1093\/rheumatology\/ker299","DOI":"10.1093\/rheumatology\/ker299"},{"key":"ref39","doi-asserted-by":"crossref","unstructured":"Govind N, Ally MM, Tikly M, Anderson R, Hodkinson B, Meyer PW. Pitfalls in the assessment of smoking status detected in a cohort of South African RA patients. 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