Researchers who looked at data from 17 studies involving nearly 5,000 adults with ankylosing spondylitis found that the more people smoked, the more likely they were to report pain and problems with mobility. Those who smoked more than 10 cigarettes a day had significantly worse health-related quality of life than people who didn’t smoke, according to the findings, published in the April 2017 issue of Seminars in Arthritis and Rheumatism. “The mechanism by which smoking affects ankylosing spondylitis isn’t established, but we think that it’s related to the pro-inflammatory effects of smoking,” says Vibeke Videm, MD, PhD, an ankylosing spondylitis researcher at NTNU, the Norwegian University of Science and Technology in Trondheim, Norway. “However, we cannot exclude that one or more of the many substances in smoke may have other harmful effects on the joints.” For doctors, the research establishing a connection between smoking and ankylosing spondylitis has been a positive development. “To find something that somebody can actually modify and change their risk for is unusual but welcome,” says Simpson Bobo Tanner IV, MD, a rheumatologist and assistant professor in the division of rheumatology and immunology at Vanderbilt University Medical Center in Nashville, Tennessee. In addition to taking medications to manage ankylosing spondylitis, quitting smoking may be one of the best steps a person can take to gain some control over the condition, Dr. Tanner says. Smoking cessation is encouraged by the American College of Rheumatology as a way to avoid aggravating ankylosing spondylitis.

Why You Shouldn’t Smoke if You Have Ankylosing Spondylitis

There are many reasons to stop smoking if you have ankylosing spondylitis:

  1. Smoking increases the risk of heart disease and stroke. People with ankylosing spondylitis have an increased risk of heart-related issues, stroke, and blood clots, according to an analysis of health data from nearly 300,000 Swedish adults, published in the May 2017 issue of Arthritis Research & Therapy. And smoking can further increase this risk. The American Heart Association states that smoking doubles your risk of heart disease independent of any other chronic conditions you have and emphasizes that anyone concerned about heart health should avoid smoking.
  2. Smoking makes breathing more difficult. This can be especially problematic in people with ankylosing spondylitis, which can cause the rib cage to stiffen, making it difficult to take a deep breath. “People with ankylosing spondylitis can have restrictive lung disease because they’re unable to expand their lungs, so smoking would be very bad in that situation,” says Atul Deodhar, MD, a rheumatologist and medical director of the rheumatology clinics at Oregon Health & Science University in Portland.
  3. Smoking can exacerbate the pain of ankylosing spondylitis. In the analysis published in Seminars in Arthritis and Rheumatism, the researchers found that smokers with ankylosing spondylitis reported both more pain and a lower quality of life than nonsmokers.
  4. Smoking can decrease the benefits of exercising for ankylosing spondylitis. Exercise is one of the best things people with ankylosing spondylitis can do to help relieve symptoms and manage the condition, according to the Spondylitis Association of America. And research published in November 2016 in Arthritis Research & Therapy showed that six months of an exercise program improved disease activity and spinal mobility in people with ankylosing spondylitis. But since smoking can reduce lung function and affect your cardiovascular system, according to the American Lung Association, you won’t get the full benefit of exercise until you quit.
  5. Smokers with ankylosing spondylitis tend to have more spinal damage than nonsmokers with the condition. This was another finding of the Seminars in Arthritis and Rheumatism analysis. Smoking can also speed up rate of spinal fusion, according to the American College of Rheumatology.
  6. Smoking may affect your treatment plan. Anti-TNF biologic medications have made a big difference for people with ankylosing spondylitis, Tanner explains. But smokers may not be getting the full benefit. A Danish study published in the journal Rheumatology in April 2016 showed that current and former smokers had poorer anti-TNF treatment response and adherence to treatment than people who had never smoked.
  7. Smoking is associated with restless legs. When researchers looked at health data from 130 people with ankylosing spondylitis and 91 people without the condition, they found that restless leg syndrome was more common among those with ankylosing spondylitis and that smoking was one of the possible reasons. The results appeared in January 2015 in the International Journal of Rheumatic Diseases. If you have ankylosing spondylitis and are trying to quit smoking, be patient with yourself if your initial efforts don’t work. Multiple ways exist to help you quit, so talk with your doctor about finding a smoking cessation strategy that can maximize your efforts to quit.