Rheumatology Advance Access originally published online on August 20, 2009
Rheumatology 2009 48(10):1227-1231; doi:10.1093/rheumatology/kep211
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Smoking is associated with increased cartilage loss and persistence of bone marrow lesions over 2 years in community-based individuals
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 Victoria, Carlton, Australia.
Correspondence to: Flavia Cicuttini, Department of Epidemiology and Preventive Medicine, Monash University, Central and Eastern Clinical School, Alfred Hospital, Melbourne, Victoria 3004, Australia. E-mail: flavia.cicuttini{at}med.monash.edu.au
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Abstract |
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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.
KEY WORDS: Bone marrow lesions, Smoking, Cartilage, Osteoarthritis
Submitted 4 February 2009;
revised version accepted 18 June 2009.
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