Rheumatoid arthritis and smoking: putting the pieces together
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
Arthritis Research & Therapy 2009, 11:238 doi:10.1186/ar2751Published: 3 August 2009
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.