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health your year to quit smoking and drinking Spring is on its way and with it comes renewed life and vigour. We look at ways to embrace the change of season and shake off the cobwebs Words: HeatHer StepHen i f you made a new years resolution to drink less or give up smoking, chances are youve already reneged on your promises. According to a YouGov survey, only 10 per cent of ushave never broken a January vow. But while you know drinking too much and smoking are bad for you, the health risks in relation to rheumatoid arthritis (RA) mean its even more important to stay on top of the game. ra and smoking the links between rheumatoid arthritis and drinking are less clearly drawn than with smoking Smoking doesnt just make RA worse, it also means youre more likely to get it something worth passing on if you have friends or colleagues who smoke. Even light smokers are at risk, says John Ioannou, consultant in adolescent and adult rheumatology at University College London Hospitals (UCLH). How smoking does this isnt entirely clear, but its thought to be related to the formation of certain antibodies to proteins in the body that are affected by chemicals from smoking. Your genes also play a part in how smoking affects your risk of developing RA. People with a certain set of genes within an area of DNA called HLA-DRB1, who also smoke, are much more likely to get rheumatoid arthritis than someone who doesnt smoke. This is most often seen in people with RA who are rheumatoid-factor positive and have something called the shared epitope, says Ioannou. People with this genetic coding who smoke also tend to have a more severe form of RA. From this, its reasonable to predict that, for many people with RA who smoke, remission is more likely if they were to stop. Outside of the increased risk factors for RA, smokers are also less likely to respond as well to antiinflammatory treatments, suchasmethotrexate and TNF-inhibitor therapies. On top of that, much like smoking, RA is a risk factor for heart disease and stroke. This is because the inflammation caused by RA narrows the blood vessels. If you smoke as well as have RA, youre really putting your cardiovascular system at risk, says Ioannou. I can understand how difficult it is to stop smoking, especially with a diagnosis of RA. However, because of the associated risks, I always encourage patients with the right support to stop. giving up Stopping smoking is one of the most common resolutions made at new year, says Amanda Sandford, information manager at Action on Smoking and Health (ASH). But if you tried to give up in January and failed, dont beat yourself up. It takes real determination to stopsmoking, but the more often you try, the greater the chances of succeeding so dont give up giving up. Wait a while, then try again. Research shows that people who get professional support for example, from their GP or use a licensed quitting aid, such as nicotine patches, are four times more likely to quit than someone who goes it alone. E-cigarettes have also been proven to help, says Sandford. ra and drinking The links between rheumatoid arthritis and drinking are less clearly drawn than with smoking, but that doesnt mean that youre off scot-free. Alcohol doesnt aggravate or contribute to the risk of developing RA, like smoking does, says DrRobert Bernstein, a consultant rheumatologist at the Alexandra Hospital in Manchester. But it doesnt mix well with some medicines, such as methotrexate andleflunomide, which are two of thebest treatments we have for rheumatoid arthritis. Alcohol is metabolised by the liver. When we drink, our livers work overtime to process the alcohol, which is why people who drink too much over a lengthy period of time can develop liver damage. Methotrexate and leflunomide are also processed by the liver, so the risk of liver damage is increased in people who drink too much though research is limited on exactly how much is safe to drink. If a patient doesnt drink sensibly, it puts me off starting methotrexate or leflunomide, says Bernstein. New guidelines suggest that men and women do not regularly drink more than 14 units of alcohol per week. Whats more, you should spread your drinking over three days or more if you do drink as much as this. But if you are taking methotrexate or leflunomide, men and women need to keep consumption down to less than 10units a week, says Bernstein. Drinking is also renowned for affecting balance. This increases the risk of injury in people with RA, who can be less nimble and more likely to fall because of stiff, painful joints and use of psychotropic medications, such as anti-depressants. how to cut down You may have already cut out alcohol as part of Alcohol Concerns Dry January, but if you missed it, why not make it a dry February or March? Six months after completing Dry January in 2015, 67 per cent of people were drinking less, or cutting out alcohol completely, says Alcohol Concerns chief executive Jackie Ballard. Having a month off can help break bad habits and kick-start a new relationship with alcohol, making it easier to cut down in the long term.