Topics

Intro
Cigarette Smoke
Nicotine
Carbon Monoxide
Other Substances
Smoke and Bone
Bone Healing
Wound Healing
Osteonecrosis
Lower Back Pain
Arthritis
Dupuytrens
RSD (CRPS)
Summary
Bibliography

Arthritis

Osteoarthritis

Surprisingly, most studies indicate a negative correlation between cigarette smoking and the development of osteoarthritis in weight bearing joints. Two separate studies have found a negative association with osteoarthritis of the knee31 88 and one study noted a negative correlation with osteoarthritis of the hip.57

Smoking may have a protective effect for the development of osteoarthritis in weight bearing joints and the reasons for the relationship are unclear. A inverse correlation between osteoporosis and osteoarthritis has been identified.34 24 Since most studies also indicate an association of osteoporosis among smokers, it is possible that the decrease in bone density associated with smoking may be the important factor. It is interesting to note, however, that smoking does not offer protection from Heberden's Nodes or degenerative osteoarthritis of the distal interphalangeal joints of the fingers.40

Rheumatoid Arthritis

Environmental factors are considered important for the development of rheumatoid arthritis. Several authors have noted a significant increase in frequency of rheumatoid arthritis among smokers.108 32 41 42 110 Fischer notes that tobacco was introduced to Europe from the New World in 1600. It was not until 1800 that rheumatoid arthritis was initially described in Europe, possibly related to the rise in tobacco use.32

In an effort to separate environmental factors from genetic factors, Silman investigated twins with rheumatoid arthritis. A strong association between smoking and the development of rheumatoid arthritis was present among both monozygotic and dizygotic twins.97 The biological reason for the association of smoking and rheumatoid arthritis remains to be determined.