title: Smoking and osteoarthritis: is there an association? The Clearwater Osteoarthritis Study.
abstract: OBJECTIVE
  To evaluate the association between cigarette smoking and the subsequent development of osteoarthritis (OA) at four separate sites: knee, hand, foot and cervical spine.
  
  
  METHODS
  This cohort study examined 2505 men and women aged 40 years and older participating in the longitudinal Clearwater Osteoarthritis Study (1988-current). Biennial physical exams, including serial radiographs, as well as historical information, were collected. The Lawrence and Kellgren ordinal scale was used to determine radiological evidence of the study outcome, OA. Self-reported history of smoking behavior was used to determine the study exposure. Smoking was classified using four approaches: (1) ever/never, (2) former/never, (3) current/never, and (4) dose.
  
  
  RESULTS
  Among the individuals at study entry, radiologically confirmed incident OA was detected during the follow-up period at four sites: knee (32%), hand (49%), foot (28%), and cervical spine (52%). Approximately 11% were self-reported current smokers. Unadjusted analyses indicated that individuals classified as current smokers demonstrated significant levels of protection from OA at all four sites investigated. However, adjusted point estimates ranging from 0.60-1.48 were suggestive of no association between smoking and the development of OA at any of the four sites investigated.
  
  
  CONCLUSIONS
  Based upon the findings of this prospective study, smoking does not appear to convey a clinically significant level of protection against the development of radiologically-confirmed OA. While these findings corroborate previous studies indicating no association between smoking and OA, anecdotal evidence warrants investigation into the role that cigarette smoking may play in the symptomatology of OA.
authors.affiliation: The Arthritis Research Institute of America, Inc. 300 South Duncan Avenue Suite #240, Clearwater, FL 33755, U.S.A. fwilder@preventarthritis.org
authors.forename: F V
authors.initials: FV
authors.lastname: Wilder
authors.forename: B J
authors.initials: BJ
authors.lastname: Hall
authors.forename: J P
authors.initials: JP
authors.lastname: Barrett
mesh_terms: D015331:Cohort Studies; D005260:Female; D033023:Foot Joints; D006225:Hand; D006801:Humans; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000209:etiology*; D020370:Osteoarthritis, Knee / Q000209:etiology; D011446:Prospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*; D013131:Spine