Smoke gets in your eyes - or is it Optic Neuritis?

I've noticed, among people that I know, that a lot of people with MS seem to smoke. I've often wondered whether it's the smoking that causes their MS, or having MS that makes them not want to give up. Or is there a third factor that's related to both of them?

Incidentally, I should declare a conflict of interest here, being on day 3 of giving up smoking. If I should come over all sanctimonious ex-smoker, you have my full permission to kill me, OK?

Smoking is now accepted as a risk factor for MS (as is passive smoking), and it appears that it may also make the disease course worse, both clinically and on MRI. Heavier smoking seems to increase the risk. Smoking is also associated with the type of MS someone has. Current smokers are more likely to have primary progressive MS, and smokers progress from relapsing-remitting MS to secondary progressive MS faster than those who have never smoked.

In addition, people with MS who smoke are more likely to have other auto-immune conditions, such as lupus, Crohn's disease, or pernicious anaemia. It seems that nicotine can precipitate the inflammatory response. Having more than one condition affects the length of time between symptom onset and diagnosis, disability progression, and health-related quality of life.

Smoking is associated with disruption of the blood-brain barrier, which will make it easier for immune system cells to get through and cause damage, with more lesions, and with more atrophy (wasting away) of the brain.

Do smokers with MS get the same encouragement as others to give up? Several friends with MS have told me of their GPs saying, in as many words:

In your situation, if smoking makes you happy - carry on!

In other cases, people may feel that they're buggered physically anyway, so why go through the stress of giving up? One friend told me that she resented being told to give up smoking, something she enjoyed doing, when she'd already lost so much.

Many people with MS also smoke those special herbal cigarettes for people with MS.

Could the smoking of cannabis by people with MS (most often for the relief of pain or spasticity, or to help with sleep) be linked to the high levels of cigarette smoking? After all, many cannabis users smoke cigarettes.

So what conclusions can we reach? Yes, smoking is a risk factor for MS - as it is for many other conditions. There's no question that it would be sensible for us not to start smoking, and if we have started, to stop. But we're not necessarily sensible. There are all sorts of reasons people smoke, that can outweigh possible, statistical risks.

I'm not going to tell anyone to give up smoking. I smoked for many years when I was fully aware of the risks - not just for my MS, but everything else too. I'm giving up now because I think it's finally the right time, for me. We all need the facts though, to be able to make an informed decision about risks and benefits.

Now, back to Smoke Gets In Your Eyes:

(Smoke Gets In Your Eyes is a classic song, a standard, and very many people have recorded it. But being the age I am, this is the version I most remember, and one I love.)