PsA and Smoking

Smoking has been associated with an increased risk of both psoriasis and psoriatic arthritis (PsA) in the general population.1-3 One large study found that those who smoked were 27% more likely to develop psoriatic arthritis than non-smokers.Paradoxically, studies have not shown an increased risk of psoriatic arthritis in people who have pre-existing psoriasis and smoke.1,4-6

However, other studies have found that people with PsA who smoke tend to have more severe disease and may have poorer responses to treatment compared to non-smokers.3,7,8 Individuals who have smoked for longer and consume more cigarettes per day tend to develop more severe PsA.Smoking may cause an increase in inflammatory cytokines, which are involved in causing PsA and are targeted by some of the biologic therapies that are used to treat PsA.9-12


It is recommended that people with PsA quit smoking.10,13 Quitting smoking can have several other benefits, including a reduced risk of cardiovascular disease, which patients with PsA are at a higher risk for developing.13-15 There are many different medications and psychological support programs available to assist with smoking cessation. 


  1. Xie W, Huang H, Deng X, Gao D, Zhang Z. Modifiable lifestyle and environmental factors associated with onset of psoriatic arthritis in patients with psoriasis: A systematic review and meta-analysis of observational studies. J Am Acad Dermatol. 2021;84(3):701-711. doi:10.1016/j.jaad.2020.08.060
  2. Armstrong AW, Harskamp CT, Dhillon JS, et al. Psoriasis and smoking: a systematic review and meta-analysis. Br J Dermatol. 2014;170:304-314. 
  3. Li W, Han J, Qureshi AA. Smoking and risk of incident psoriatic arthritis in US women. Ann Rheum Dis. 2012;71:804-808. 
  4. Nguyen UDT, Zhang Y, Lu N, et al. Smoking paradox in the development of psoriatic arthritis among patients with psoriasis: a population-based study. Ann Rheum Dis. 2018;77(1):119-123. doi:10.1136/annrheumdis-2017-211625
  5. Gazel U, Ayan G, Solmaz D, Akar S, Aydin SZ. The impact of smoking on prevalence of psoriasis and psoriatic arthritis. Rheumatology (Oxford). 2020;59(10):2695-2710. doi:10.1093/rheumatology/keaa179
  6. Eder L, Shanmugarajah S, Thavaneswaran A, et al. The association between smoking and the development of psoriatic arthritis among psoriasis patients. Ann Rheum Dis. 2012;71(2):219-224. doi:10.1136/ard.2010.147793
  7. Højgaard P, Glintborg B, Hetland ML, et al. Association between tobacco smoking and response to tumour necrosis factor α inhibitor treatment in psoriatic arthritis: results from the DANBIO registry. Ann Rheum Dis. 2015;74(12):2130-2136. doi:10.1136/annrheumdis-2014-205389
  8. Di Lernia V, Ricci C, Lallas A, Ficarelli E. Clinical predictors of non-response to any tumor necrosis factor (TNF) blockers: a retrospective study. J Dermatolog Treat. 2014;25(1):73-74. doi:10.3109/09546634.2013.800184
  9. Veale DJ, Fearon U. The pathogenesis of psoriatic arthritis. Lancet. 2018;391(10136):2273-2284. doi:10.1016/S0140-6736(18)30830-4
  10. Meer E, Merola JF, Fitzsimmons R, et al. Does biologic therapy impact the development of PsA among patients with psoriasis?. Ann Rheum Dis. 2022;81(1):80-86. doi:10.1136/annrheumdis-2021-220761
  11. Pezzolo E, Naldi L. The relationship between smoking, psoriasis and psoriatic arthritis. Expert Rev Clin Immunol. 2019;15(1):41-48. doi:10.1080/1744666X.2019.1543591
  12. Yanagita M, Kobayashi R, Kojima Y, Mori K, Murakami S. Nicotine modulates the immunological function of dendritic cells through peroxisome proliferator-activated receptor-γ upregulation. Cell Immunol. 2012;274(1-2):26-33. doi:10.1016/j.cellimm.2012.02.007
  13. Singh JA, Guyatt G, Ogdie A, et al. Special Article: 2018 American College of Rheumatology/National Psoriasis Foundation Guideline for the Treatment of Psoriatic Arthritis. Arthritis Rheumatol. 2019;71(1):5-32. doi:10.1002/art.40726
  14. Critchley J, Capewell S. Smoking cessation for the secondary prevention of coronary heart disease. Cochrane Database Syst Rev. 2004;(1):CD003041. doi:10.1002/14651858.CD003041.pub2
  15. Critchley JA, Capewell S. Mortality risk reduction associated with smoking cessation in patients with coronary heart disease: a systematic review. JAMA. 2003;290(1):86-97. doi:10.1001/jama.290.1.86