Smoking cessation counseling was documented in 10% of visits and was less likely when rheumatoid arthritis (RA) was controlled, a recent study found. Given smoking's impact on RA and long-term outcomes, systematic cessation counseling efforts are needed. Researchers examined predictors of tobacco counseling in patients with RA who smoke, including the effect of perceived RA control. This secondary data analysis involved patients with RA who had an additional cardiovascular disease risk factor identified in an academic medical center 2004-2011. They abstracted 3,396 RA visits, including 360 visits (10%) with active smokers, and found:

• Perceived controlled RA was present in 31% of visits involving smokers (39% in nonsmokers).
• Beyond nurse documentation, providers documented smoking status in 39% of visit notes with smokers and smoking cessation counseling in 10%.
• Visits with controlled vs active RA were less likely to include counseling.
• Counseling was more likely in visits with prevalent cardiovascular, pulmonary, and psychiatric disease, but decreased with obesity.