Cigarette smoking and the risk for cartilage loss and knee pain in men with knee osteoarthritis

OBJECTIVE To examine the effects of smoking on cartilage loss and pain at the knee in individuals with knee osteoarthritis. METHODS 159 men with symptomatic knee osteoarthritis who participated in a 30-month, prospective, natural history study of knee osteoarthritis were examined. The more symptomatic knee was imaged using magnetic resonance imaging (MRI) at baseline, and again at 15 and 30 months of follow-up. Cartilage was scored using the Whole-Organ MRI Score semiquantitative method at the medial and lateral tibiofemoral joints and at the patellofemoral joint. At baseline and follow-up visits, the severity of knee pain was assessed using a Visual Analogue Scale pain score (0-100 mm). RESULTS Among the 159 men, 19 (12%) were current smokers at baseline. Current smokers were younger (mean (standard deviation (SD)) age 62 (9) v 69 (9) years) and leaner (mean (SD) body mass index (BMI): 28.9 (3.2) v 31.3 (4.8) kg/m(2)) than men who were not current smokers. When adjusted for age, BMI and baseline cartilage scores, men who were current smokers were found to have an increased risk for cartilage loss at the medial tibiofemoral joint (odds ratio (OR) 2.3, 95% confidence interval (CI) 1.0 to 5.4) and the patellofemoral joint (OR 2.5, 95% CI 1.1 to 5.7). Current smokers also had higher adjusted pain scores at baseline (60.5 v 45.0, p<0.05) and at follow-up (59.4 v 44.3, p<0.05) than men who were not current smokers. CONCLUSIONS Men with knee osteoarthritis who smoke sustain greater cartilage loss and have more severe knee pain than men who do not smoke.

[1]  P. McDonough,et al.  Smoking-Induced Elevations in Blood Carboxyhaemoglobin Levels , 1999, Sports medicine.

[2]  R. Fogelholm,et al.  Smoking and intervertebral disc degeneration. , 2001, Medical hypotheses.

[3]  Y. Uematsu,et al.  Effects of nicotine on the intervertebral disc: an experimental study in rabbits , 2001, Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association.

[4]  Ali Guermazi,et al.  The relationship between cartilage loss on magnetic resonance imaging and radiographic progression in men and women with knee osteoarthritis. , 2005, Arthritis and rheumatism.

[5]  T. Spector,et al.  Cigarette smoking and risk of osteoarthritis in women in the general population: the Chingford study. , 1993, Annals of the rheumatic diseases.

[6]  R. Moskowitz,et al.  Development of criteria for the classification and reporting of osteoarthritis. Classification of osteoarthritis of the knee. Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association. , 1986, Arthritis and rheumatism.

[7]  L. Kazis,et al.  The Association of Bone Marrow Lesions with Pain in Knee Osteoarthritis , 2001, Annals of Internal Medicine.

[8]  A. Rivard,et al.  Inhibition of hypoxia‐induced angiogenesis by cigarette smoke exposure: impairment of the HIF‐lalpha/VEGF pathway , 2003, FASEB journal : official publication of the Federation of American Societies for Experimental Biology.

[9]  A. Avcı,et al.  Acute effects of smoking of cigarettes with different tar content on plasma oxidant/antioxidant status. , 2000, Inhalation toxicology.

[10]  C. Hogstedt,et al.  Osteoarthrosis of the knee in men and women in association with overweight, smoking, and hormone therapy , 1999, Annals of the rheumatic diseases.

[11]  R A Deyo,et al.  Lifestyle and Low-Back Pain: The Influence of Smoking and Obesity , 1989, Spine.

[12]  R A Boileau,et al.  The physical activity scale for the elderly (PASE): evidence for validity. , 1999, Journal of clinical epidemiology.

[13]  J J Anderson,et al.  Factors associated with osteoarthritis of the knee in the first national Health and Nutrition Examination Survey (HANES I). Evidence for an association with overweight, race, and physical demands of work. , 1988, American journal of epidemiology.

[14]  G. Ejlertsson,et al.  Widespread musculoskeletal chronic pain associated with smoking. An epidemiological study in a general rural population. , 1998, Scandinavian journal of rehabilitation medicine.

[15]  N. Mayo,et al.  A Review of the Association Between Cigarette Smoking and the Development of Nonspecific Back Pain and Related Outcomes , 2000, Spine.

[16]  A. Goodship,et al.  Effect of Nicotine on Spinal Disc Cells: A Cellular Mechanism for Disc Degeneration , 2004, Spine.

[17]  H. Matsuzaki,et al.  Degeneration of intervertebral discs due to smoking: experimental assessment in a rat-smoking model , 2004, Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association.

[18]  Wei Li,et al.  Bone Marrow Edema and Its Relation to Progression of Knee Osteoarthritis , 2003, Annals of Internal Medicine.

[19]  H. Genant,et al.  Whole-Organ Magnetic Resonance Imaging Score (WORMS) of the knee in osteoarthritis. , 2004, Osteoarthritis and cartilage.

[20]  R. Karpman,et al.  Smoking and osteoarthritis: differential effect of nicotine on human chondrocyte glycosaminoglycan and collagen synthesis. , 2005, Osteoarthritis and cartilage.

[21]  W. Kannel,et al.  Does smoking protect against osteoarthritis? , 1989, Arthritis and rheumatism.

[22]  K Lund-Olesen,et al.  Oxygen tension in synovial fluids. , 1970, Arthritis and rheumatism.

[23]  M. Tiku,et al.  Evidence Linking Chondrocyte Lipid Peroxidation to Cartilage Matrix Protein Degradation , 2000, The Journal of Biological Chemistry.

[24]  C. Brighton,et al.  Anaerobic and aerobic metabolism in articular cartilage. , 1977, The Journal of rheumatology.

[25]  M. Glimcher,et al.  Systemic hypoxia alters gene expression levels of structural proteins and growth factors in knee joint cartilage. , 2005, Biochemical and biophysical research communications.

[26]  M. Doherty,et al.  Is osteoarthritis in women affected by hormonal changes or smoking? , 1993, British journal of rheumatology.

[27]  B. Swoboda,et al.  Hypoxia and HIF-1α in osteoarthritis , 2005, International Orthopaedics.

[28]  H. Valkenburg,et al.  A 12 year follow up study in the general population on prognostic factors of cartilage loss in osteoarthritis of the knee. , 1992, Annals of the rheumatic diseases.

[29]  Daniel Levy,et al.  Risk factors for incident radiographic knee osteoarthritis in the elderly: the Framingham Study. , 1997, Arthritis and rheumatism.

[30]  P. Wolf,et al.  The effects of specific medical conditions on the functional limitations of elders in the Framingham Study. , 1994, American journal of public health.

[31]  R. Luukkonen,et al.  Smoking and Overweight as Predictors of Hospitalization for Back Disorders , 2003, Spine.

[32]  H. Matsuzaki,et al.  Mechanism of Intervertebral Disc Degeneration Caused by Nicotine in Rabbits to Explicate Intervertebral Disc Disorders Caused by Smoking , 2002, Spine.

[33]  F. Wilder,et al.  Smoking and osteoarthritis: is there an association? The Clearwater Osteoarthritis Study. , 2003, Osteoarthritis and cartilage.

[34]  S. Jimenez,et al.  Hypoxia inducible factor-1 alpha expression in human normal and osteoarthritic chondrocytes. , 2004, Osteoarthritis and cartilage.

[35]  J. Moreland,et al.  Radiographic analysis of the axial alignment of the lower extremity. , 1987, The Journal of bone and joint surgery. American volume.