by Dr. Harbeer Ahedi
Smoking, chewing tobacco, the constant use of mishri, beedi, paan, hookah, cigars is a common practice all over India and the world. Not only men, but also women, both in urban and rural regions are known to use tobacco almost everyday and have become “addicted” to it. Not only elderly but youngsters are more often seen smoking or chewing tobacco.
The word tobacco is derived from the Arabic word “tabaq” meaning “euphoria” producing herb. Tobacco seems to be as old as human civilization. Tobacco’s easy assimilation into cultural of rituals of many societies was facilitated by the medicinal and perhaps intoxicating effects of it in the past. India is the world’s second largest producer of tobacco and also the second largest consumer of un-manufactured tobacco.
As tobacco slowly integrated itself in the society man has slowly come to know about its ill effects such as cancer, heart diseases and lung diseases of various kinds. A condition known as the oral submucous fibrosis is an emerging new epidemic especially among the youth who use gutka or paan masala. Chronic obstructive pulmonary disease, gastric and duodenal ulcers, delayed conception in women, effect on reproductive systems of both sexes, increased risk of spontaneous abortion in pregnant tobacco users are some more conditions caused due to tobacco.
It is known that in non-smokers’ lung cancer and coronary heart disease can develop by passive smoking, ie. by being close to the smokers.
And now it’s a known fact that, many kinds of arthritis are linked to tobacco consumption, including “degeneration of bones”.
Why do people consume tobacco ?
As the centuries have passed man has become more and more inclined to a known toxin like tobacco. The question is why ? Historically tobacco consumption has been linked with social status and commonality. Tobacco consumption has been related with different symbolic and often moral overtones across all societies. The habit of rural men, usually assembled in caste-based or social class- based groups sharing hookah in daily gathering, is an example of fellowship, solidarity and the consultative process. Paan consumption is considered as a ritual in many communities in India.
Smoking habits which might have their origins in rebellion or the thrill of illicit experimentation, have become linked with freedom and equality among those who have suffered social or gender inequality. In youngsters it might be due to peer pressure, that in time turns into habit and further on in addiction.
In rural regions, men and women simply use tobacco in the form of mishri in their daily routine and slowly become so addicted to it that their daily routine is not complete without its use.
In many cultures across the world smoking cigarettes or cigars is a symbol of higher status. The use of tobacco in women in urban women is often seen as a symbol of liberation and modernity.
As the times have changed, the socio economic pressure on man has increased, may it be of money, work or family. Frustrations, worries, money or depression may also incline a man to start using tobacco for psychological satisfaction and relief from stress.
In case of arthritis chewing or smoking tobacco or use of gutkha may make the user relieved of his or her pains and aches but the constant use can lead to severity and increase in the disease activity leading to more inflammation and joint pains.
How does it enter into one’s body ?
Nicotine is the principal constituent of tobacco and responsible for its addictive character. In case of people using cigar, smoke or hookah, tobacco enters the body and directly affects the lungs. When tobacco is burned, the resultant smoke contains in addition to nicotine, carbon monoxide and > 4000 other compounds that result from volatilization, pyrolysis and pyrosynthesis of tobacco and various chemical addictives used in making different tobacco products. The smoke is composed of a fine aerosol with predominantly particle size distribution and deposit in the airways and alveolar surfaces of the lungs. The bulk of toxicity and carcinogenicity of the smoke resides in aerosolized phase that contains a large number of toxins. The vapor phase contains carbon monoxide, respiratory irritants and ciliotoxins as well as many volatile compounds that are responsible for the distinctive odor. Its constant use leads to cardiovascularand lung disease.
In the case of people using misri, gutka and paan, the tobacco blends in the mouth and sufficient amount of nicotine is absorbed to satisfy the user’s needs. In such cases the tobacco doesn’t reach the lungs but primarily affects the mucosa leading to the cancer of the oral cavity.
Use of tobacco increases the levels of nicotine in the blood and this causes the blood vessels to narrow. Nicotine constricts blood vessels to about 25% of their normal thickness. Because of the constriction of the vessels, decreased levels of nutrients are supplied to the bones. This leads to the effect on bone healing and also increases the chancing of earlier degeneration of the bones. One of the common denominators for many of the above damaging effects of smoking is the effect on the microcirculation in your body. Microcirculation is the tiny network of blood vessels in the nooks and gaps of your body. It is vitally important for nutrition, repair and remodeling at the tissue and cellular level, especially in the musculoskeletal system. Smoking related chemicals literally shut down the microcirculation, starving those areas of needed supplies required for optimal function.
Effects on musculoskeletal systems :
Rheumatoid arthritis
Use of tobacco is hazardous for bones and joints.
Smoking or use of mishri has an etiological association with rheumatoid arthritis. Tobacco users are likely to develop nodules and can be positive for rheumatoid factor. Patients who have used tobacco in the past or are current smokers are more likely to have high levels of rheumatoid factor and are at an increased risk for bone erosion. Moreover, those who have smoked for more than 25 years have three times the rheumatoid factor and bone erosion risks of nonsmokers. Also the ESR in such patients is always on the higher side. Vaculitis in RA seems to be related with smoking.
Osteoporosis.
Osteoporosis is the degeneration of bones. It usually occurs in the
elderly and after menopause in women. But in the case of smokers the onset of degeneration is early as it causes weakening of the bone.
Fracture healing.
Long standing smoking or use of tobacco leads to weakening
of bones and if such bone is broken the rate of healing in tobacco users is much slower (delayed union) or in some cases they do not completely heal (non-union).
Back pain.
Smokers have a higher incidence of lower back problems, including
back pain and degenerative disc disease. Smokers who undergo spinal fusion surgery have significantly higher failure rates in which the fusion does not take place. Spine surgeons often require that patients stop smoking before having certain spine related surgical procedures.
Muscle / tendon tears.
Smokers seem to get into difficulty with tendons that lack
optimal blood supply and healing capability – like the rotator cuff in the shoulder. It’s believed it also affects tendons involved in tennis elbow and Achilles tendinitis.
Replantation hand surgery.
lf someone is unfortunate enough to accidentally
have a finger cut off, and hand surgeons re-attach it, even secondhand smoke in the vicinity of that patient will cause the replanted finger to turn blue. This is the most obvious direct result of smoking’s ability to choke off circulation complications. Smokers are also at higher risk for a wide variety of non-orthopedic complications after undergoing orthopedic surgical procedures.
Smoking can also lead to avascular necrosis, further leading to secondary osteoarthritis.
Soft tissue Rheumatism is also seems to be more aggressive in people using tobacco. In
Psoriatic arthritis many researchers have shown a relationship between smoking and psoriasis, especially palmopustular psoriasis. Indirect effects of cigarette smoking include poor wound healing in Raynaud’s disease. Recognition of dermatologic signs of tobacco use can be a clue to many of the serious underlying systemic diseases associated with smoking.
Fight against Tobacco.
The process of stopping smoking is often a cynical one, with the smoker sometimes making multiple attempts to quit and failing before finally being successful.
Media campaigns, changes in workplace rules to restrict smoking in the office, nicotine replacement therapy are all useful enhances of long tem cessation success. Prevention of smoking initiation must begin early preferably in the elementary school years and also in educational institutes to make the coming generations aware of the dangers and risk due to use of any kind of tobacco.
Physicians and clinician who are aware of the patients condition should educate the patient of the harmful effects on his body and should repeatedly ask the patient to quit.