KIU Publications

Arthritis represents a growing non-communicable disease (NCD) burden in East Africa, driven by demographic transition, urbanization, lifestyle changes, and persistent inflammatory triggers. Tobacco smoking and alcohol consumption are modifiable behavioral exposures implicated in arthritis incidence, severity, and progression, particularly in rheumatoid arthritis (RA), osteoarthritis (OA), and gout. While extensive data exist from Europe and North America, evidence from East Africa remains fragmented. This review synthesizes current knowledge on the mechanistic and epidemiological links between smoking, alcohol use, and arthritis progression in East African populations. Smoking promotes citrullination, autoantibody formation, oxidative stress, and pro-inflammatory cytokine activation, accelerating RA severity and structural joint damage. Alcohol exhibits complex dose-dependent effects: moderate consumption may show immunomodulatory properties, whereas heavy use exacerbates gout, systemic inflammation, liver dysfunction, and medication toxicity. Sociocultural practices, co-infections, malnutrition, occupational exposures, and limited rheumatology services modify these associations in East Africa. We highlight regional knowledge gaps and propose research and public health priorities to mitigate arthritis progression through targeted behavioral interventions.