Based on PubMed | Does smoking increase the risk of developing arthritis or worsen existing arthritis symptoms?

Smoking is linked to a higher risk of developing certain types of arthritis and can make existing arthritis harder to manage. In particular, cigarette smoking increases the chance of getting rheumatoid arthritis (an autoimmune form) and tends to worsen disease activity and outcomes in those who continue to smoke. ^{[1] [2]} It can also make it more difficult to stay physically active, which is important for controlling pain and stiffness from any arthritis. ^[3]

Key takeaways

• Rheumatoid arthritis (RA): Smoking raises the risk of developing RA and is associated with worse symptoms and control if you keep smoking. ^{[1] [2]} Quitting is recommended as part of RA care because smoking can make RA worse. ^[4]
• Osteoarthritis (OA): The relationship is less clear; high‑quality analyses do not show a protective effect of smoking on OA development or progression, and overall there is no compelling evidence that smoking slows OA. ^{[5] [6]}
• Treatment response: Heavier smoking has been linked to poorer response and drug persistence with biologic therapies (such as anti‑TNF) in RA. ^[7]
• Overall health impact: Beyond joints, smoking increases cardiovascular risk, which is already elevated in inflammatory arthritis, adding to the overall disease burden. ^[8]

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How smoking affects rheumatoid arthritis

• Higher risk of getting RA: Long‑term smoking is a recognized environmental risk factor for RA. ^{[1] [2]}
• Worsening disease activity: Continuing to smoke appears to make RA more active and harder to control. ^{[2] [4]}
• Reduced treatment effectiveness: Evidence suggests heavy smokers have a poorer response and shorter “drug survival” on anti‑TNF biologics, likely due to immune and inflammatory effects of tobacco smoke. ^[7]
• Extra‑articular complications: Smoking is associated with more RA complications outside the joints (for example, nodules and cardiovascular events), increasing overall risk. ^[8]

Bottom line for RA: Smoking increases the likelihood of RA and can worsen outcomes if you already have RA; quitting is a recommended part of management. ^{[1] [4]}

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What about osteoarthritis?

The evidence does not support any benefit of smoking for OA.

• No protective effect on OA progression: A meta‑analysis of 16 observational studies (nearly one million participants) found no significant association between smoking and OA progression. ^[5]
• Earlier “protective” signals likely biased: Another comprehensive review found that reports suggesting smoking protects against OA were likely due to selection bias, especially in hospital‑based case–control studies. ^[6]

Bottom line for OA: Smoking does not reduce OA risk or progression, and it carries many harms that can indirectly worsen joint health by limiting fitness and healing. ^{[5] [6]}

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Practical implications for people with arthritis

• Symptom control and function: Staying active is central to arthritis care, but smoking can make it harder to be physically active, undermining pain and stiffness control. ^[3]
• Care plan: Clinical guidance for RA includes “don’t smoke,” because it can make RA worse and quitting can help improve disease control over time. ^[4]
• Prevention: Because smoking increases the chance of getting RA, avoiding or quitting smoking is a reasonable step to lower risk. ^{[1] [2]}

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Summary table

Arthritis type	Does smoking increase risk?	Does smoking worsen symptoms/outcomes?	Notes
Rheumatoid arthritis (RA)	Yes. Smoking increases RA risk. [1] [2]	Yes. Continuing to smoke is linked to worse disease and poorer treatment response. [4] [7]	Quitting is part of standard RA advice. [4]
Osteoarthritis (OA)	No clear increase or decrease. Earlier “protective” findings likely biased. [6]	No evidence of benefit; no reduction in progression. [5]	Smoking harms overall health and activity levels, which can indirectly worsen joint function. [3]

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Quitting support

Stopping smoking can be challenging, but many users find it helps pain control, energy, and treatment response over time. Evidence‑based quit resources (counseling, nicotine replacement, medications) improve success rates, and clinical teams routinely encourage cessation as part of arthritis care. ^{[4] [3]}

If you’re considering a quit plan, options like phone counseling, text programs, or local cessation services can offer tailored support. ^[1]

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The bottom line

• Yes smoking increases the risk of developing rheumatoid arthritis and can make arthritis, particularly RA, worse. ^{[1] [2]}
• For osteoarthritis, smoking does not slow disease and offers no joint benefit; prior signals of protection appear to reflect bias. ^{[5] [6]}
• Quitting smoking is a practical step that can support better arthritis control and overall health. ^[4]