Axial spondyloarthritis, also known as AxSpa, is a chronic inflammatory disease of axial or central skeleton. It mainly affects the spine and sacroiliac joint in pelvis. The most common symptom of axial spondyloarthritis is lower back ache and in severe cases, it can cause complete fusion and rigidity of the spine. Axial spondyloarthritis commonly occurs more often in males and in second or third decades of life.

Various studies have shown that smokers with early axial spondyloarthritis have earlier disease onset and more disease activity, poor functions and health related quality of life, damage and inflammatory changes. It was observed in different studies that cigarette smoking was independently associated with earlier onset of axial spondyloarthritis, increased axial structural damage on Magnetic resonance imaging (MRI) and radiograph.

A new research which was published online in Annals of the Rheumatic Disease revealed that smoking also hampers the response to biological drugs which are used for treatment of axial spondyloarthritis.

In Swiss Clinical Quality Management Cohort (SCQMS) between the periods of 2005 to 2014 a study was conducted to analyze the response of less than 700 patients with diagnosis of axial spondyloarthritis who were being treated with tumor necrosis factor (TNF) inhibitors, a class of biological drugs. The subjects were divided into two groups- smokers and non-smokers. Out of 700, two third (62%) were involved in cigarette smoking and 38% of them were non-smokers.

The treatment responses of these subjects were analyzed based on Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Ankylosing Spondylitis Disease Activity Score (ASDAS). These are standard diagnostic tests used by rheumatologist to measure the effectiveness of drug therapy in axial spondyloarthritis cases. The BASDAI is measured on a scale of 1 to 10 (1-no symptoms and 10-symptoms worsened) on the basis of six questions which include Fatigue, Spinal pain, Arthralgia, inflammation, and morning stiffness duration and severity. There were other factors which would influence the score of BASDAI like age, sex, weight, exercises etc. which were all considered while analyzing the results. The complete history and smoking status were available for nearly 70 % of the total subjects taken into the study (<500).

In comparison with non-smokers, the subjects who smoked throughout the treatment showed poor response to the treatment given and lesser improvement in their BASDAI and ASDAS scores. The subjects who had higher levels of inflammatory markers (C-reactive protein [CRP]) by the end of the study as compared to the beginning of the study showed noticeable differences. Overall only 10% to 20 % of current smokers achieved a 50 % reduction in BASDAI score even after 1 year treatment.

The researchers concluded that cigarette smoking hampers the response of tumor necrosis factor inhibitor but how, was not clear from the study. The study revealed that cigarette smoking may increase the CRP or interfere with neural processing of sensory information or starve patients of oxygen there by increasing the pain. Consider quitting smoking to improve your health and reduce your risk of back pain.


  1. Ciurea, A. Scherer, U. Weber, P. Exer, J. Bernhard, G. Tamborrini, M. Riek, R. B. Muller, B. Weiss, M. J. Nissen, R. Kissling, B. A. Michel, A. Finckh. Impaired response to treatment with tumour necrosis factor inhibitors in smokers with axial spondyloarthritis. Annals of the Rheumatic Diseases, 2015
  2. Chung HY,Machado Pvan der Heijde DD’Agostino MADougados MAnn Rheum Dis. 2012 Jun; 71(6):809-16. doi: 10.1136/annrheumdis-2011-200180. Epub 2011 Oct 11.
  3. The above story is based onmaterials provided by BMJ-British Medical Journal, Pubmed and Wikipedia