RESEARCH - Smoking is associated with increased cartilage loss and persistence of bone marrow lesions over 2 years in community-based individuals

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Rheumatology Advance Access originally published online on August 20, 2009

Rheumatology 2009 48(10):1227-1231; doi:10.1093/rheumatology/kep211

Smoking is associated with increased cartilage loss and persistence of

bone marrow lesions over 2 years in community-based individuals

Miranda L. Davies-Tuck1, Anita E. Wluka1,2, Forbes1, Yuanyuan

Wang1, Dallas R. English3,4, Graham G. Giles4 and Flavia Cicuttini1

1Department of Epidemiology and Preventive Medicine, Monash

University, Central and Eastern Clinical School, Alfred Hospital,

2Baker Heart Research Institute, 3Centre for Molecular, Environmental,

Genetic and Analytic Epidemiology, School of Population Health, The

University of Melbourne, Melbourne and 4Cancer Epidemiology Centre,

Cancer Council , Carlton, Australia.

Abstract

Objective. To determine whether smoking is related to change in tibial

and patella cartilage, and the development or persistence of bone

marrow lesions (BMLs) over 2 years in a cohort of middle-aged adults.

Methods. Two hundred and seventy-one adult subjects recruited from the

Melbourne Collaborative Cohort Study underwent an MRI of their

dominant knee at baseline and 2 years later. Cartilage volume and BMLs

were determined for both time points. At baseline, subjects also

completed a questionnaire about current and past cigarette smoking.

Results. Being a ‘smoker’ (former or current) was associated with

increased annual loss of medial but not lateral or patella cartilage

volume (medial: difference = 13.4 µl, P = 0.03; lateral difference =

4.86 µl, P = 0.45, patella difference = –2.57 µl, P = 0.79). A

relationship between increasing pack-years smoked and increased medial

cartilage volume loss was also observed (P = 0.04). Amongst people who

had a BML at baseline, BMLs present in ‘ever smokers’ were 11.4 [95%

confidence interval (CI) 1.54, 89.9; P = 0.02] times more likely to

persist over 2 years than those present in ‘never smokers’. In

addition, the relationship between smoking and increased medial

cartilage loss for subjects with a BML present at baseline was

partially mediated by the persistence of the BMLs over 2 years.

Conclusion. This study contributes to the evidence of a detrimental

effect of smoking on joint cartilage. Furthermore, it provides a

possible mechanism that the association smoking shares with increased

cartilage loss may be mediated via smoking impairing the ability for

BMLs to resolve.

http://rheumatology.oxfordjournals.org/cgi/content/abstract/48/10/1227?etoc

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