Rheumatoid Arthritis: Independent and Synergistic Effects of Vitamin D Deficiency and Smoking

REVIEW
Abdulsalam A. Noorwali

 

For citation: Noorwali AA. Rheumatoid Arthritis: Independent and Synergistic Effects of Vitamin D Deficiency and Smoking. International Journal of Biomedicine. 2026;16(3):314-319. doi:10.21103/Article16(3)_RA3

Originally published September 5, 2026

Abstract: 

Rheumatoid arthritis (RA) is a long-term autoimmune disease in which the immune system mistakenly attacks the joint linings. The exact cause of RA is still not evident. However, a combination of environmental and genetic factors is considered to contribute to RA. Smoking is an established environmental condition/ risk that exacerbates the disease activity and severity, including faster joint damage, increased lung and other systemic complications, and decreased efficacy of medication used by RA patients. There are a number of factors that synergistically affect the health of smokers, RA patients, or smoking RA patients. Vitamin D (VitD) is one of the main factors involved in smoking and RA. Regarding synergistic influences and interactions, assessing inflammatory biomarker levels (e.g., high-sensitivity C-reactive protein [hs-CRP]) indicates that the inflammatory influence of VitD deficiency is significantly amplified and stronger in smokers than in non-smokers. Furthermore, smoking, a known environmental factor in interaction with the genetic factors, causes a synergistic risk of severe RA. Although both smoking and VitD are established risk factors for RA, the intricate details about how they influence independently are not clearly known. (International Journal of Biomedicine. 2026;16(3):314-319.)

Keywords: 
rheumatoid arthritis • smoking • vitamin D
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Received June 3, 2026.
Accepted July 15, 2026.
© 2026 The Author(s). International Journal of Biomedicine is published by IMRDC. This is an open access article under the CC BY-NC-ND 4.0 license.