Smoking can significantly increase the risk of developing rheumatoid arthritis and may worsen symptoms, a new study published by the World Health Organization (WHO) reports. The study also found that women are significantly more likely to suffer from the disease than similarly-aged men.

Researchers aren’t sure why smoking is so closely tied to RA, but they think that inhaling tobacco smoke stimulates the release of compounds known as pro-inflammatory cytokines. These compounds are known to be involved in the development and progression of RA.

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