Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China; Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, USA; The Mongan Institute, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Department of Biostatistics and Epidemiology, University of North Texas Health Science Center, School of Public Health, Texas, USA.
Osteoarthritis Cartilage. 2021 May;29(5):697-706. doi: 10.1016/j.joca.2021.02.382. Epub 2021 Feb 20.
Smoking represents a major issue for global public health. Owing to methodologic challenges, findings of an association between smoking and risk of knee osteoarthritis (OA) are inconsistent. We sought to assess the relation of onset of smoking cessation to the risk of OA sequelae, i.e., knee replacement, and to perform sub-cohort analysis according to weight change after smoking cessation.
Using The Health Improvement Network, we conducted a cohort study to examine the association between smoking cessation and risk of knee replacement among patients with knee OA. Participants who stopped smoking were further grouped into three sub-cohorts: weight gain (body mass index [BMI] increased>1.14 kg/m), no substantial weight change (absolute value of BMI change<1.14 kg/m), and weight loss (BMI loss>1.14 kg/m) after smoking cessation.
We identified 108 cases of knee replacement among 1,054 recent quitters (26.7/1,000 person-years) and 1,108 cases among 15,765 current smokers (17.4/1,000 person-years). The rate difference of knee replacement in recent quitter cohort vs current smoker cohort was 10.4 (95% confidence interval [CI]:5.3-15.6)/1,000 person-years and the adjusted hazard ratio (HR) was 1.30 (95%CI:1.05-1.59). Compared with current smokers, risk of knee replacement was higher among quitters with weight gain (HR = 1.42,95%CI:1.01-1.98), but not among those with no substantial weight change (HR = 1.29,95%CI:0.90-1.83) or those with weight loss (HR = 1.11,95%CI:0.71-1.75).
Our large population-based cohort study provides the first evidence that smoking cessation was associated with a higher risk of knee replacement among individuals with knee OA, and such an association was due to weight gain after smoking cessation.
吸烟是全球公共卫生的主要问题。由于方法学上的挑战，吸烟与膝关节骨关节炎（OA）风险之间的关联的研究结果并不一致。我们旨在评估戒烟与 OA 后果（即膝关节置换）之间的关系，并根据戒烟后体重变化进行亚组分析。
利用健康改善网络，我们进行了一项队列研究，以检查膝关节 OA 患者中戒烟与膝关节置换风险之间的关系。戒烟的参与者进一步分为三组：体重增加（体重指数[BMI]增加>1.14kg/m）、体重无明显变化（BMI 变化绝对值<1.14kg/m）和戒烟后体重减轻（BMI 减轻>1.14kg/m）。
我们在 1054 名近期戒烟者中发现了 108 例膝关节置换（26.7/1000 人年），在 15765 名当前吸烟者中发现了 1108 例（17.4/1000 人年）。在近期戒烟者队列与当前吸烟者队列中，膝关节置换的发生率差异为 10.4（95%置信区间[CI]：5.3-15.6）/1000 人年，调整后的风险比（HR）为 1.30（95%CI：1.05-1.59）。与当前吸烟者相比，体重增加的戒烟者发生膝关节置换的风险更高（HR=1.42，95%CI：1.01-1.98），但体重无明显变化者（HR=1.29，95%CI：0.90-1.83）或体重减轻者（HR=1.11，95%CI：0.71-1.75）并非如此。
我们的大型基于人群的队列研究首次提供了证据表明，在患有膝关节 OA 的个体中，戒烟与膝关节置换风险增加相关，而这种关联归因于戒烟后的体重增加。
