Yes smoking is associated with a higher risk of developing rheumatoid arthritis (RA), and it can also make RA more severe if it develops. ^[1] Smoking has been linked to both the onset of RA and worse symptoms and outcomes, including higher disease activity and difficulty staying physically active. ^{[2] [1]}

What the Evidence Shows

• Public health guidance: Major health agencies state that smoking increases the chance of getting RA and can worsen the condition in those who already have it. ^{[1] [2]}
• Overall risk increase: Large analyses of observational studies show that people who smoke have a higher chance of RA than never‑smokers; in men, the odds can be roughly 1.8–1.9 times higher, and in women about 1.2–1.3 times higher. ^[3] These differences may reflect varying biology, exposure, or study populations. ^[3]
• Heavier exposure, higher risk: The risk rises with cumulative smoking (pack‑years). Even 1–10 pack‑years is associated with about a 26% higher risk, and ≥20 pack‑years is linked to roughly a twofold increase versus never smoking. ^[4] This “dose–response” pattern strengthens the case that smoking plays a causal role. ^[4]
• Seropositive RA risk: Smoking is most strongly tied to “seropositive” RA particularly rheumatoid factor (RF)–positive and anti‑citrullinated protein antibody (ACPA)–positive RA. ^{[3] [4]} For example, in some analyses, the risk for RF‑positive RA in men who smoke is about 3–4 times higher than in never‑smokers. ^[3] Studies in different populations (including Asian cohorts) also show increased odds for ACPA‑positive RA among smokers, with clear dose effects. ^[5]
• Gene–environment interaction: Smoking interacts with certain HLA‑DRB1 “shared epitope” genes, amplifying the risk of ACPA‑positive RA; in people carrying two copies of these genetic variants, over half of ACPA‑positive RA cases may be attributable to smoking. ^[6] This means smoking can “unlock” risk in genetically susceptible individuals. ^[6]

How Smoking May Contribute to RA

• Immune activation: Cigarette smoke promotes inflammation and can lead to protein changes (citrullination) in the lungs, potentially triggering autoimmunity (e.g., ACPA formation) in predisposed people. ^[6]
• Systemic effects: Ongoing smoking sustains inflammatory pathways and may worsen joint inflammation, drive higher disease activity, and impair response to therapy in RA. ^{[7] [8]}

Does Quitting Help?

• Risk declines after quitting: Stopping smoking appears to reduce RA risk over time, although some excess risk may persist for years compared with never‑smokers. ^[9] In one large cohort of women, those who quit for longer periods had progressively lower risk than recent quitters, suggesting meaningful long‑term benefit. ^[9]
• Disease course: Among people with RA, quitting smoking is generally associated with better symptom control and improved overall health, which supports RA management and quality of life. ^{[1] [2]}

Practical Takeaways

• Smoking raises RA risk particularly seropositive RA and the risk increases with more years and quantity smoked. ^{[3] [4]}
• Secondhand and early-life exposure matter: Exposure to parental smoking in childhood has been linked to higher RA risk later in life, highlighting the importance of smoke‑free environments. ^[10]
• Quitting is protective: While the elevated risk does not disappear overnight, the sooner someone quits, the more the risk falls over time, and quitting also supports better RA outcomes if the disease develops. ^{[9] [11]}

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Key Data at a Glance

Aspect	Summary	Evidence
Overall association	Smoking increases RA risk and worsens RA course	[1] [2]
Magnitude of risk (men)	Ever, current, past smokers: OR ~1.9; RF+ RA ORs higher (≈3.0–3.9)	[3]
Magnitude of risk (women)	Ever, current, past smokers: OR ≈1.2–1.3; higher with RF+	[3]
Dose–response (pack‑years)	1–10 pack‑years: RR ~1.26; 21–30 pack‑years: RR ~1.94; plateau >40 pack‑years	[4]
Seropositive RA (ACPA/RF)	Stronger link; ACPA‑positive risk notably elevated, including in Asian cohorts	[4] [5]
Genetics interaction	With HLA‑DRB1 SE, smoking accounts for ~35% of ACPA‑positive RA; up to 55% with two SE copies	[6]
Smoking cessation	Risk declines with time after quitting, though may remain above never‑smokers for years	[9]

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Bottom Line

• Yes, smoking increases the risk of developing rheumatoid arthritis, especially the seropositive forms (RF/ACPA positive), and the risk grows with heavier or longer smoking. ^{[3] [4]}
• Quitting smoking meaningfully reduces future risk and supports better health outcomes overall. ^{[9] [1]}

If you’re considering quitting, there are effective tools and support programs that can increase your chances of success. ^[1]