Benefits of Quitting Smoking for People With Ankylosing Spondylitis

Smoking harms your lungs, heart, and general health. Research on people with ankylosing spondylitis (AS) shows that smoking also worsens the impact of this illness and promotes its progression.

Smokers with this disease are likely to have more severe symptoms and a higher disease burden (impacts on finances, mortality, disability, and other metrics) than those with the same illness but who don't smoke. Smoking can also affect your response to proven treatments.

The good news is that it's never too late to quit. The impact of quitting smoking can help you control the disease and increase your chances of having better disease outcomes.

This article describes how smoking impacts disease progression in ankylosing spondylitis, the benefits of quitting, and tips for stopping smoking.

Person with nicotine patch on their upper arm with hand written message saying "not today"

Lucy Lambriex / Getty Images

Smoking as a Risk Factor for AS

While scientists don't know exactly what causes ankylosing spondylitis, an inflammatory autoimmune disease affecting the bones of the spine, certain risk factors can make you more likely to develop the disease. Research suggests that smoking is a significant risk factor for the incidence and progression of ankylosing spondylitis.

In a study that examined how smoking contributes to the progression of ankylosing spondylitis, researchers observed that current smokers were more likely to have a recent diagnosis than anklyosing spondylitis than previous smokers or nonsmokers.

Based on these findings, smoking should be discouraged in people with a high risk of developing ankylosing spondylitis due to other factors such as family history or being positive for the HLA-B27 gene. This gene is found in 90% of people with the disease.

Risks of Smoking with Ankylosing Spondylitis

Research indicates that smoking interferes with an ability to control symptoms of AS. Generally, people who smoke with ankylosing spondylitis are worse off than nonsmokers with AS.

Increased Pain

Smoking can intensify joint pain in ankylosing spondylitis. In an analysis of nearly 5,000 adults with AS, researchers reported that those who smoked were more likely to report more pain than nonsmokers.

In a study that examined the impact of smoking on ankylosing spondylitis, people in the smoking group had longer duration of morning joint stiffness and less spinal mobility compared to people in the nonsmoking group.

Higher Risk of Heart Disease and Stroke

Ankylosing spondylitis places people at an increased risk for heart disease due to chronic inflammation. When chronic inflammation damages the aorta (the large artery carrying blood from the heart to the circulatory system), it can block blood flow or damage the aortic valve in the heart. Inflammation can also interfere with the heart's normal electrical system and cause changes in heart rhythm.

One cardiovascular problem linked with ankylosing spondylitis is stroke. In one study, people with ankylosing spondylitis had an increased stroke risk of 56% than those without AS. A higher risk of stroke can occur due to blood clots that form in the veins, deep vein thrombosis, and pulmonary embolisms (blood clots that travel to the lungs) with ankylosing spondylitis.

Smoking is also a major risk factor for heart disease. Any amount of smoking can damage your heart. Smoking further increases the risk of heart disease and stroke in people with other heart disease risk factors, such as ankylosing spondylitis.

More Spinal Damage

Smoking is linked with faster-progressing spinal damage in ankylosing spondylitis. A 2019 meta-analysis examined whether a link existed between smoking and cumulative radiographic (seen on X-ray) spinal damage and progression in people with ankylosing spondylitis.

Researchers reported that smoking was linked with increased cumulative damage to the spine in people with ankylosing spondylitis.

A 2021 study that observed the relationship between cigarette smoking and spinal damage in people with ankylosing spondylitis found that 50% of those who smoked had more significant radiographic progression than nonsmokers.

Exercise and Treatment May Be Less Effective

Smoking harms your lungs and breathing. In a 2021 review of people with ankylosing spondylitis, researchers identified a statistically significant decrease in chest expansion among smokers.

When ankylosing spondylitis affects your ribs, it can make it difficult or painful to expand your chest to breathe. If you smoke, you will further limit your ability to breathe freely and to exercise at the recommended rate to make a positive impact on your health.

Smoking can also make certain treatments for ankylosing spondylitis less effective. In a 2016 study of people with ankylosing spondylitis treated with a tumor necrosis factor (TNF) inhibitor, current and former smokers had significantly worse patient-reported effects of the condition at baseline, shorter treatment adherence, and poorer treatment responses.

Benefits of Quitting Smoking for People With AS

Quitting smoking is strongly advised for people with ankylosing spondylitis. Data from a study of more than 900 people with ankylosing spondylitis found that people who stopped smoking achieved lower levels of disease activity, better physical function, and improved quality of life compared to current smokers.

In this study, researchers estimated that people who stopped smoking achieved benefits that were comparable to 30% of the effects they might get with intensive physical therapy and 16% of the effects they might get with taking biologic medications.

Slower Disease Progression

Quitting or reducing your smoking may help slow disease progression in ankylosing spondylitis. There is evidence that inflammation from smoke inhalation quickens the rate at which disease damage progresses. When you stop smoking, this trigger doesn't contribute to disease progression.

Less Inflammation and Stiffness

In a study of people with axial spondyloarthritis (ankylosing spondylitis is a form of axial spondyloarthritis), researchers determined that, among smokers, smoking cessation is linked with lower disease activity and better physical function.

Smoking also promotes inflammation by increasing levels of inflammatory markers such as C-reactive protein. Research indicates that C-reactive protein (CRP) levels are related to the risk of ankylosing spondylitis. Research shows that when people stop smoking, inflammation decreases throughout their body.

Improved Quality of Life

Quitting smoking can improve quality of life. Researchers leading a 2019 observational study reported significant improvements in quality of life and other disease factors among people with ankylosing spondylitis who stopped smoking. Other treatment outcomes linked to quitting smoking included improvements in disease activity, physical mobility, and lung function.

Tips for Quitting

Even when motivated by health concerns, quitting smoking can be challenging. This is true regardless of how long you've been smoking.

While almost 70% of adults who currently smoke say they want to quit, just over 50% of smokers attempt to quit annually. Ultimately, fewer than 10% succeed in quitting each year. Despite the availability and effectiveness of proven smoking cessation treatments, fewer than 33% of people who smoke take advantage of these options when trying to quit.

If you're serious about quitting, consider these tips:

  • Make a plan and follow it: Select a specific date to quit. Dispose of cigarettes, ashtrays, cigarette lighters, and other objects that may trigger a desire to smoke. Use air fresheners to remove the scent of smoke in your home and car. Be ready to execute your plan on your specified date.
  • Decide if you want to quit smoking alone or seek help from a healthcare provider: A healthcare provider can advise you of the benefits of medical and natural ways of quitting smoking. They can prescribe a nicotine patch to help curb urges and smoking cessation medication that can make smoking less pleasurable if you decide to smoke.
  • Manage urges and situations in which you may encounter triggers: Identify your triggers for smoking and avoid situations in which you may be susceptible to these triggers. To prevent temptation, find ways to distract yourself when you're in situations in which you smoked in the past.
  • Stay active: Physical activity can help you manage the inevitable cravings and stress when quitting. When you crave a cigarette, even short periods of activity like taking a quick walk or running in place can distract you and change your focus.
  • Find alternative ways to keep your mouth and hands busy: When you have the urge to smoke, try chewing sugarless gum or hard candy to replace your craving for oral stimulation. Drink plenty of water to change the taste in your mouth and help flush out residual nicotine and other toxins that remain from smoking.
  • Practice relaxation techniques. If you smoked to relieve stress, find other ways of relaxing. Consider deep breathing, yoga, or meditation to reduce stress and help you remain calm without relying on nicotine.
  • Get support. Ask family and friends for support to help you avoid triggers and achieve your goal. Connect with a smoking-cessation support group or counselor in person, online, or via social media. The free telephone quitline 800-QUIT-NOW (800-784-8669) provides support and counseling.


Smoking increases your risk of ankylosing spondylitis. It also raises your chances of having a worse disease course with AS.

People with this disease and smoke are likely to have more spinal damage earlier, more spinal stiffness, and more problems moving. Smokers are also more likely to have a worse quality of life than those with this disease who don't smoke.

Nonsmokers who have AS have a chance of better outcomes than people who smoke. Research on people with this illness shows that smoking also makes it harder to achieve results from treatments proven to help slow the progress of the disease and relieve symptoms.

While quitting smoking can improve your disease outcomes, many people struggle with making a long-term break from nicotine. Those who succeed can look forward to better results with this chronic illness.

Frequently Asked Questions

  • Does smoking increase joint inflammation and pain?

    Smoking causes vasoconstriction (narrowing of blood vessels), which results in a reduction of blood flow to your bones and tissues. This promotes degeneration and damage in the discs of the spine, causing pain.

  • Is it safe to use the patch and other smoking cessation aids while receiving treatment for AS?

    The safe combination of smoking cessation aids and treatment for spondylitis depends on the types of medications used. The nicotine patch may interact with some medications, including Tylenol (acetaminophen).

    To avoid adverse reactions from combining a smoking cessation product with treatment for ankylosing spondylitis, check with your healthcare provider before using smoking cessation products.

  • What other lifestyle choices can make ankylosing spondylitis worse?

    Research suggests that having two or more unhealthy lifestyle factors is associated with negative physical and mental health for people with ankylosing spondylitis. The most common lifestyle choices that contributed to this effect include being overweight/having obesity, not adhering to recommendations for health-enhancing levels of physical activity, and tobacco use.

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By Anna Giorgi
Anna Zernone Giorgi is a writer who specializes in health and lifestyle topics. Her experience includes over 25 years of writing on health and wellness-related subjects for consumers and medical professionals, in addition to holding positions in healthcare communications.