Pip Aimer, Lisa Stamp, Simon Stebbings, Natalia Valentino, Vicky Cameron, Gareth J. Treharne

Objectives: The aim of this study was to investigate disease-related issues which make smoking cessation challenging for patients with rheumatoid arthritis (RA). There is currently a lack of research on tailoring smoking cessation interventions for RA patients. Qualitative exploration is a necessary first step in planning targeted interventions. Methods: A qualitative mixed methods study was undertaken. Participants attended either a focus group or an individual interview and completed a set of standardized questionnaires. The sample consisted of 36 RA patients: 24 current smokers and 12 ex-smokers. The transcripts were analysed thematically using a critical realist approach to inductively identify themes. Results: Five key barriers to smoking cessation which are faced by RA patients were identified. Firstly, participants were unaware of the causative relationship between smoking and RA and hence did not perceive this as a reason to quit. Secondly, smoking was used as a distraction from pain. Thirdly, participants found it difficult to exercise and hence were unable to use exercise as an alternative distraction. Fourthly, smoking was used as a coping mechanism for the frustrations of living with RA. Fifthly, participants felt unsupported and isolated from other RA patients. Conclusions: Disease-related issues may hinder smoking cessation for RA patients. Through an understanding of patients' perspectives there is an opportunity to plan an effective targeted intervention that may increase the chance of smoking cessation in RA patients where smoking may adversely influence disease progression and comorbidities. © 2014 American College of Rheumatology.