People with rheumatoid arthritis and lupus tend to use smoking as a relief from their pain or as a “crutch,” but smoking can increase the severity of cardiovascular and rheumatic diseases. However, only 10 percent of rheumatology visits include cessation counseling, according to a new study published in Arthritis Care & Research co-authored by Brittany Bettendorf, MD, clinical assistant professor in Immunology. The study was led by principal investigator Christie Bartels, MD, at the University of Wisconsin.

By collecting data from members of focus groups, the group assessed the obstacles preventing smoking cessation therapy. Bettendorf collaborated with nine other professionals from the University of Wisconsin and the Medical College of Wisconsin to interview 19 people with rheumatoid arthritis and systemic lupus erythematosus who smoke regularly.

“The University of Wisconsin implemented a new smoking cessation protocol, and we sought to understand patients’ reactions to the protocol and to understand patient-centered outcomes or ‘signs of progress’ related to smoking addiction,” Bettendorf said. This new protocol led to a 20-fold increase in the number of referrals to smoking cessation counseling than before.

Many of the participants, Bettendorf revealed, were unaware that smoking was worsening their rheumatologic condition. People felt more likely to quit once they had received education about how smoking can affect their condition and how to go about cutting back or quitting altogether.

“One of the important things I learned from participating in this research was the patient’s perspective on their smoking. One of my fears as a physician is that when I counsel a patient about cutting back on smoking is that they will see this as my ‘harping’ on them,” Bettendorf said. “What I learned was that they don’t view it this way at all, and in fact when a provider does not address this with them they can interpret it as a lack of caring.”