Pipe Down!

"If they were friends, smoking and AS would be joined at the hip."

Rheumatologist Dr Shashank Akerkar looks at the reasons why people with ankylosing spondylitis might smoke (and how This AS Life could help).

Smoker? This isn't going to be a lecture - we promise

This AS Life doesn’t need to tell you cigarettes cause cancer – you know that already. We thought that instead of making you feel guilty, we’d examine why people with a rheumatic disease smoke.

Why? Because tackling the reasons why you smoke could make it more likely you’ll want to quit – and that you’re able to as well. So here are some top five reasons people with a rheumatic disease smoke and some This AS Life advice on how to tackle them.

Reason 1: "I had no idea cigarettes made my AS worse"

This AS Life tip: Keep reading…

If they were friends, smoking and AS would be joined at the hip. Smoking with AS causes nearly as many AS-related problems as it does general health ones.1,2 Smoking makes AS more likely to develop1 and makes all manner of symptoms worse too.2 In fact, the more you smoke, the worse it is both for some symptoms and the damage to your skeleton.3 Cigarettes also dent quality of life for people with AS – and cut how effective some AS treatments can be by nearly half.2,4

So how come, according to one study, significantly more people with AS smoke than the general population?5 Maybe the next four reasons sound familiar…

Reason 2: "I'm in pain a lot. I smoke to cope"

This AS Life tips: Talk to your doctor about better pain control. Read about painsomnia.

Pain is a big part of life with AS.6 And chronic pain is a big part of why people smoke.7In one U.S. study, while the percentage of smokers in the general population steadily declined over 15 years, the proportion of smokers with chronic pain stayed the same.7

Even if it’s not advisable, it’s perhaps understandable. It’s ironic too: for AS, more cigarettes mean more symptoms, which means more pain (and maybe more cigarettes too).1,2Maybe fewer cigarettes could even be a great form of AS pain control? 

Reason 3: "I can’t exercise with AS, so I smoke instead"

This AS Life tips: Exercise loves AS. Read about physiotherapy

Many quitters use exercise to fight cravings:8 exercise helps mimic the mental ‘buzz’ people get from smoking.9Regular exercise is great for AS, as well as willpower. It reduces pain and increases spinal mobility (and quality of life).10,11It might be the last thing you feel like doing, but exercise is a great thing to do to fight AS and your cravings too.10,11

This AS Life tip: Get connected. Read about how to speak AS, positive thinking, find support

Reason 4: "Having AS makes me feel isolated – and feel like a cigarette"

Sadly, it’s not surprising that loneliness can be part of life with a rheumatic disease: flares, being off sick or unable to work can all keep people at home and on their own.1214 Loneliness isn’t something anyone can solve in a sentence– it’s a complex topic, with lots of factors15– but staying as social as possible sounds like a positive way to help keep it at bay.

Social media (and sites like This AS Life) are a great way of being social in your own home. Talking to friends and loved ones about how you feel is important too – as well as your doctor. They might be able to offer good advice, as well as understanding.

Reason 5: "It helps me cope with the frustration of having AS"

This AS Life tip: Get empowered. Read any and every article on This AS Life for advice, plus join a patient group near you in our find support section.

Smoking is just one way people cope with a chronic condition like AS and whatever else life throws at you. The main reason This AS Life exists is to offer sensible, expert advice to the AS community, where it’s often in short supply.

With this article, and every other, This AS Life offers ways to deal with the things AS throws your way. Hopefully, there’s something in here that helps; something that makes giving up cigarettes seem a little less daunting and a lot more possible. Good luck!


This article was written by Dr Shashank Akerkar, with help from the resident experts at ThisASLife.com. A social site, helping the whole AS community to: Learn. Share. Inspire. Discuss.


1. Videm V et al. J Rheumatol 2014; 41:2041–2048.
2. Wendling D, Prati C. Expert Rev Clin Immunol; 9:511–516.
3. Poddubnyy D et al. Ann Rheum Dis 2013; 72:1430–1432.
4. Ciurea A et al. Ann Rheum Dis 2015; annrheumdis-2013-205133. doi: 10.1136/annrheumdis-2013-205133. [Epub ahead of print].
5. Papgoras C et al. Joint Bone Spine 2014; 81:57–63.
6. Schneeberger EE et al. Clin Rheumatol 2015; 34:497–501.
7. Orhurhu VJ et al. Tob Induc Dis 2015; 13:17.
8. Roberts V et al. Psychopharmacology (Berl) 2012; 222:1–15.
9. Janse Van Rensburg K et al. Psychopharmacology (Berl) 2009; 203:589–598.
10. Lim HJ et al. Rheumatol Int 2005; 25:225–229.
11. Durmus D et al. Rheumatol Int 2009; 29:673–677.
12. Kool MB, Geenen R. J Psychol 2012; 146:229–241.
13. Cooksey R et al. Rheumatology (Oxford) 2015; 54:1563–1572.
14. Castillo-Ortiz JD et al. Arthritis Care Res (Hoboken) 2015 Sep 28. doi: 10.1002/acr.22730. [Epub ahead of print].
15. Bucholz ES, Catton R. Adolescence 1999; 34:203–213.



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Dr Shashank

Consultant Rheumatologist

Dr Shashank Akerkar is a Consultant Rheumatologist at the Mumbai Arthritis Clinic and Research Centre in India. Describing himself as a ‘patient-centric Rheumatologist’, Dr Akerkar regularly tweets and blogs on a range of rheumatology topics (including ankylosing spondylitis). He is also the creator of an app specifically for patients with lupus.

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