Smoking and Rheumatoid Arthritis:a toolkit for Rheumatology teams

Development and Printing funded by Pfizer Ltd, August 2012. Ref code: NPKAM0050

NHS Fife case study

The Fife Rheumatology smoking cessation campaign targeted patients with Rheumatoid Arthritis to raise awareness of the harmful impact that smoking can have on both their condition and also the treatments used to manage it.

The Rheumatology team worked closely with the local Stop Smoking Service to establish referral pathways, and had support from Pfizer to develop the campaign materials and to aid with implementation. NRAS also provided patient feedback on all the materials suggested, to ensure that the messages and visuals were appropriate.

The campaign encouraged and developed relationships with the local Stop Smoking Service and the Rheumatology team that

hadn’t previously existed. There was also a significant increase in the awareness of the dangers of smoking for patients with RA.

Many Rheumatology teams are now interested in implementing a similar campaign to help support their patients.

Please refer to the full case study document for further information.

Campaign materials

A range of materials have been developed that are available for teams to use. All materials will

be customized with your specific local details. The current documents can be changed to provide

bespoke materials for your specific needs.

Current materials available include:

Objectives for this toolkitThe overall objective of this toolkit is to enable Rheumatology teams to increase the smoking cessation rates of Rheumatology patients. The toolkit will help to raise awareness within the team of the importance of encouraging Rheumatology patients to quit smoking, and offer the best support to help them to do so.

n Posters – raising awareness of the dangers

of smoking and Rheumatoid Arthritis.

n Postcards – for a targeted maildrop.

n 6-page folding leaflet – with further

information for patients to use.

n Guide to help manage the campaign.

n Detailed case study of the NHS Fife

campaign.

Included in this toolkit

n NHS Fife case study

n Campaign materials

n Implementing smoking cessation advice for Rheumatology patients

n Looking at each element

n Glossary

n Background to smoking and Rheumatoid Arthritis

This toolkit has been developed by NHS Fife and Pfizer; both organisations are very keen to help

and support other teams to implement this project. For further information about how they can

support you, please contact your local Pfizer representative.

Dr. Helen Harris, NHS Fife

Implementing smoking cessation advice for Rheumatology patients

All NHS staff that are in contact with patients should be involved in a smoking cessation strategy.

When smoking cessation is not discussed with a patient, it gives the impression that smoking

is not affecting their health. The table below outlines the role and responsibilities of team

members with supporting patients to quit smoking.

Stakeholder Role

Team memberDocument

smoking statusDeliver brief

advicePrescribe

pharmaco-therapyRefer to smoking cessation services

Audit outcomes

Rheumatology Sp Nurse ✓ ✓ If trained ✓ ✓

Rheumatology AHP ✓ ✓ If trained ✓ ✓

Rheumatology Doctor ✓ ✓ ✓ ✓ ✓

Pharmacists (Hospital and Community)

✓ ✓ ✓ ✓ ✓

Rheumatology OPD Nurse ✓ ✓ ✓

NHS Clerical ✓ ✓ ✓

General Practitioner ✓ ✓ ✓ ✓

Dentist ✓ ✓ ✓

Looking at each element

n Documenting smoking status

The first element is to obtain basic information about the patient and simply ask if they

currently smoke.

“Are you a smoker or a non-smoker?”

n Delivering brief advice

Showing an understanding of addiction and displaying empathy is important when asking

smokers questions. A few brief questions can encourage smokers to think about their habit.

“Would you like to stop smoking?”

“Smoking reduces the effectiveness of your treatment.”

”Smokers need higher doses of medications than non-smokers to achieve the same effect.”

n Prescribing pharmacotherapy

Members of the Rheumatology team can prescribe NRT and other medications that help to

support smoking cessation.

n Referring to a Stop Smoking Service

Patients are four times more likely to quit smoking with NHS support than by going it alone.

Referring to a specialist service will ensure they get the best advice and support from trained

advisors. Find out the best method to refer these patients by speaking to your local Stop

Smoking Service.

n Audit outcomes

Rheumatology teams can audit a number of outcomes, including referral rates to smoking

cessation services, number of quit attempts per patient and disease activity of ex-smokers.

This will support the development of smoking cessation targets for Rheumatology teams.

Glossary

Smoking cessation

The process of discontinuing the practice of inhaling a smoked substance.

Brief advice

Term which means offering a small amount of information to help a patient understand their

current smoking behaviour.

Campaign

Used to describe the marketing and promotional materials put together to help raise awareness

of the dangers of smoking in patients with RA.

NRT

Nicotine Replacement Therapy, can be used amongst other treatment options to help a patient

to quit smoking.

Referral pathway

Describes the method and process to pass the details of a patient on effectively.

n How to refer

Different Stop Smoking Services will have different methods of capturing referrals. It’s best if

the Rheumatology team contact the local Stop Smoking Service directly, as they will probably

have referral forms and processes that they can share. Usually, Stop Smoking Services have a

set referral form that Rheumatology teams can use to refer their patients.

n Treatment options

There are various treatment options available to help people give up smoking. An intensive

behavioural support programme of six to seven sessions, combined with twelve weeks of stop

smoking medication, increases the likelihood of success by up to four times7. Alternatively

one-to-one support can be provided by many Smoking Cessation Teams.

Please contact your local Stop Smoking Service for further information about prescribing

smoking cessation medications.

The Cochrane Collaboration is a well-established, non-profit organisation, dedicated to

making up-to-date and accurate information about the effects of health care interventions

available. This is a good resource for Rheumatology teams to use, to understand more about

the effectiveness of smoking cessation therapies and the various treatments available.

www.cochrane.org Background to Smoking and Rheumatoid Arthritis

References1. Sugiyama et al. Impact of smoking as a risk factor for developing rheumatoid arthritis: A meta-analysis of observational studies: Ann Rheum Dis 2010;69:70-81. 2. Manjari Lahiri et al. Modifiable risk factors for RA: prevention, better than cure? Rheumatology 2012;51:4995123. Ulf Müller-Ladner et al. Cardiovascular risk management in patients with inflammatory arthritis: what is good for the joint is good for the heart and vice versa! F1000

Medicine Reports 2010, 2:27 (doi:10.3410/M2-27)4. Saevarsdottir et al. 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 & Rheumatism 2011;63:26-36.5. Abhishek et al. Anti-TNF-[alpha] agents are less effective for the treatment of rheumatoid arthritis in current smokers: Journal of Clinical Rheumatology 2010;16:15-18.6. Masdottir B. et al. Smoking, rheumatoid factor isotypes and severity of rheumatoid arthritis Rheumatology 2000; 39:1202-1205.7. West R, McNeill A and Raw M (2000) ‘Smoking cessation guidelines for health professionals: an update.’ Thorax 55(2):987–99

n Heavy smoking can increase the risk of

developing RA by up to 100%1.

n RA patients that smoke may have a higher

risk of cardiovascular disease2, 3.

n Smoking can weaken the effectiveness

of RA medication4, 5.

n RA may be more severe in smokers than

non-smokers6.

n Quitting smoking is one of the best things

patients can do for their RA1 - 6.