Smoking
Smokers are at risk of developing rheumatoid arthritis, especially in heavy smokers who smoke 20 cigarettes or more a day for more than 20 years. Smoking stimulates the inflammatory cells, which are the primary cells that act on rheumatoid arthritis. There is a link between smoking and the production of an anti-cyclic citrullinated peptide (anti-ACC), which can worsen rheumatoid arthritis symptoms and causing the flare-up of the disease. Smoking substances are free radicals which cause extra harm to the inflamed cells by rheumatoid arthritis.