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Smoking and Spondylitis

Medically reviewed by Ariel D. Teitel, M.D., M.B.A.
Written by Sarah Winfrey
Posted on December 13, 2021

If you’ve been diagnosed with spondylitis of any kind, it is important to understand what causes the condition and what makes it worse. Researchers have found that smoking cigarettes, in particular, correlates with worse outcomes for those with spondylitis, including higher inflammation, greater morning stiffness and nighttime back pain, impaired daily functioning, and more.

In this article, we’ll consider research on the effects of smoking on spondylitis symptoms and progression.

Smoking as a Risk Factor for Spondylitis

Smoking has been identified as a significant risk factor for developing spondylitis, especially for men. In fact, people who smoke tend to be diagnosed with spondylitis earlier than people who don't smoke. It is a good enough predictor of the condition for those with a family background of the disease that researchers recommend people who smoke and have a family history of spondylitis quit, even if they have not developed the condition yet.

Researchers are not yet sure why smoking plays a role in the development of spondylitis. Some have posited that it might be related to the connection between the effects of smoking and hypertension (high blood pressure).

The Benefits of Cutting Back or Quitting Smoking

There are some significant differences in disease activity and progression that seem to be related to smoking status. Even if you have already been diagnosed with spondylitis, quitting smoking or reducing the amount that you smoke could have a number of benefits.

Slower Disease Progression

People who do not smoke experience slower spondylitis progression than people who continue to smoke after their diagnosis. Even though the condition does progressively worsen, it does not do so as quickly in people who do not smoke as it does in those who smoke.

Researchers can see this disease progression when tracking it via X-rays (known as its radiographic progression). These X-rays have revealed that the bones in the spine change faster in people who smoke — especially in men — than they do in people who don’t smoke. Note that researchers do not yet know if this faster structural damage changes the long-term outcome of the condition.

Lower Disease Activity

Disease activity has to do both with how quickly a condition progresses and how significant an impact it has on a person’s life. It can be calculated in several ways, including with the Ankylosing Spondylitis Disease Activity Score (ASDAS), the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), and the Bath Ankylosing Spondylitis Functional Index (BASFI).

One study on cigarette smoking and spondylitis disease outcomes and progression found that people currently using tobacco received higher BASDAI and BAFSI scores compared to those who had never smoked.

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Another study on the impact of several lifestyle factors on spondylitis disease activity found that smoking correlated with a higher ASDAS over the course of a year compared to never having smoked. (However, this difference was noted to be statistically significant only in women who formerly smoked.)

Better Daily Function

Research suggests that people diagnosed with spondylitis who do not smoke, who quit smoking, or who smoke less may experience better physical functionality in daily life than people who do smoke.

Some of this has to do with the physicality of breathing. Those who don’t smoke can expand their chests farther, even given the spinal changes that take place with spondylitis. This makes breathing easier, as does avoiding the negative cardiovascular effects of smoking.

People who do not smoke and those who quit or reduce their smoking have also been found to experience less overall back pain than those who continue smoking. It is thought that cigarette smoking may increase pain by changing the way nerves operate or by preventing some tissues from getting the oxygen they need. For those who don’t smoke, this reduced pain permits them more movement and improved spinal mobility and helps them feel better overall, improving their functionality in daily life.

Lower Inflammation

People with spondylitis who quit or reduce their smoking may experience less inflammation — a major cause of pain in diseases like spondylitis. Levels of inflammation are monitored by checking for the prevalence of certain chemicals in the blood, known as inflammation markers. Higher levels of these chemicals, like C-reactive protein, indicate greater inflammation.

While researchers are not exactly sure how smoking worsens spondylitis, there are indications that inflammation from inhaling smoke is a major contributor. This inflammation is thought to quicken the rate at which spondylitis-related damage progresses.

Less Morning Stiffness

Many people diagnosed with spondylitis experience significant stiffness in the morning — particularly in the back. This can take a significant amount of time to wear off, drastically impacting what they can do and how much they can get done in a day. People who do not smoke report experiencing less severe morning stiffness, and they report that it goes away faster than it does in people who do smoke.

Less Nighttime Back Pain

Similarly, many people with spondylitis experience significant back pain at night. This may interfere with falling asleep, staying asleep, and getting enough restful sleep to face the day ahead. People who don’t smoke report experiencing less nighttime back pain overall than those who smoke. This could lead to better sleep and more sleep.

Higher Responsiveness To Biologic Medications

Rheumatologists may prescribe medications called biologics for spondylitis. These medications directly affect certain parts of the immune system, hopefully keeping spondylitis symptoms in check and slowing or stopping the progression of the disease.

Current smoking can interfere with how the body responds to these medications, causing a person to be less responsive to biologic drugs. Researchers believe that inflammation may play a role in this reduced response.

It’s possible that local inflammation from inhaling smoke triggers an inflammatory response throughout the body — one that possibly “short-circuits” or overwhelms the pathway managed by biologic medication.

People diagnosed with spondylitis who do not smoke have been found to report higher quality-of-life scores than those who do. This is likely due to a number of factors, including experiencing less pain, less inflammation, less stiffness, and higher responsiveness to medications.

How To Cut Back or Quit Smoking

If you would like to cut back on your smoking or quit entirely, reach out to your rheumatology specialist or health care provider. They may be able to prescribe smoking cessation treatment and connect you to other resources that will help. These resources can help you make a plan and stick to it, which is key when pursuing smoking cessation.

You can also try to find other people who are quitting. Working together means that you are building relationships while you’re working toward your goal. This may make it more likely that you will be successful at the endeavor.

You may find that nicotine replacement therapy (NRT) helps you make the transition away from smoking. Some NRT products are available over the counter without a prescription. Others require a prescription, like nicotine nasal sprays and inhalers. It may take some time for you to find the right NRT product.

The U.S. Food and Drug Administration (FDA) has also approved two nicotine-free medications to help with quitting smoking: varenicline tartrate (previously sold under the brand Chantix) and Zyban (bupropion). Both medications require a prescription.

Ultimately, aim to have an open, honest dialogue with your health care team and follow up with them regularly. Their job is not to judge your habit — their job is to help you on the path to becoming smoke-free.

Find Your Team

If you have been diagnosed with spondylitis and you want to quit or reduce your smoking, join us at MySpondylitisTeam today. Here, you’ll find a community of more than 73,000 members from around the world who understand life with spondylitis. You can ask questions, offer and receive support and advice, and more.

Have something to add to the conversation? Share your thoughts in the comments below or by posting on MySpondylitisTeam.

  1. Axial Spondyloarthritis and Cigarette Smoking — The Open Rheumatology Journal
  2. Impact of Smoking on Disease Outcome in Ankylosing Spondylitis Patients — The Egyptian Rheumatologist
  3. Lifestyle Factors and Disease Activity over Time in Early Axial Spondyloarthritis — The SPondyloArthritis Caught Early (SPACE) Cohort — The Journal of Rheumatology
  4. Smoking Worsens Ankylosing Spondylitis Damage — Arthritis Foundation
  5. Stopping Smoking — NASS
  6. ASDAS Calculator — ASAS
  7. BASDAI — Bath Ankylosing Spondylitis Disease Activity Index —
  8. BASFI — Bath Ankylosing Spondylitis Functional Index —
  9. Cigarette Smoking Has a Dose-dependent Relationship With Disease Activity and Correlates With More Functional Limitation and Worse Health Assessment in the Patients With Ankylosing Spondylitis — Annals of the Rheumatic Diseases
  10. Relationship Between Smoking, Clinical, Inflammatory, and Radiographic Parameters in Patients With Ankylosing Spondylitis — Egyptian Rheumatology and Rehabilitation
  11. Ankylosing Spondylitis — Symptoms — NHS
  12. How To Quit Smoking — Centers for Disease Control and Prevention
  13. Using Nicotine Replacement Therapy —
  14. Want To Quit Smoking? FDA-Approved Products Can Help — U.S. Food and Drug Administration
  15. Prescription Medicines To Help You Quit Tobacco — American Cancer Society
  16. Current Smoking Is Associated With Incident Ankylosing Spondylitis — The Hunt Population-Based Norwegian Health Study — The Journal of Rheumatology
  17. Patients With Early Rheumatoid Arthritis Who Smoke Are Less Likely To Respond to Treatment With Methotrexate and Tumor Necrosis Factor Inhibitors: Observations From the Epidemiological Investigation of Rheumatoid Arthritis and the Swedish Rheumatology Register Cohorts — Arthritis and Rheumatism
  18. Pfizer Recalls Chantix Smoking Cessation Drug for Increased Cancer Risk Due to High Levels of Nitrosamine — USA Today
Posted on December 13, 2021
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Ariel D. Teitel, M.D., M.B.A. is the clinical associate professor of medicine at the NYU Langone Medical Center in New York. Review provided by VeriMed Healthcare Network. Learn more about him here
Sarah Winfrey is a writer at MyHealthTeam. Learn more about her here

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