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Highly Accessed Review

Rheumatoid arthritis and smoking: putting the pieces together

Zsuzsanna Baka1, Edit Buzás1 and György Nagy12*

Author Affiliations

1 Department of Genetics, Cell and Immunobiology, Semmelweis University, Nagyvárad tér 4., Budapest, H-1445, Hungary

2 Department of Rheumatology, Semmelweis University, Árpád fejedelem útja 7., Budapest, H-1023, Hungary

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Arthritis Research & Therapy 2009, 11:238  doi:10.1186/ar2751

Published: 3 August 2009

Abstract

Besides atherosclerosis and lung cancer, smoking is considered to play a major role in the pathogenesis of autoimmune diseases. It has long been known that there is a connection between rheumatoid factor-positive rheumatoid arthritis and cigarette smoking. Recently, an important gene–environment interaction has been revealed; that is, carrying specific HLA-DRB1 alleles encoding the shared epitope and smoking establish a significant risk for anti-citrullinated protein antibody-positive rheumatoid arthritis. We summarize how smoking-related alteration of the cytokine balance, the increased risk of infections (the possibility of cross-reactivity) and modifications of autoantigens by citrullination may contribute to the development of rheumatoid arthritis.