Background/Purpose: Smoking has been shown to have a potential protective effect on radiographic knee osteoarthritis (OA), possibly mediated through lower body weight in smokers. A recent animal study showed an association between chronic alcohol consumption and OA-like pathological changes, whereas no studies have explored this potential association in humans. By studying the relationship between harmful health behavior and OA in the hands, we avoid mediation by body weight. Hence, our aim was to explore whether smoking and alcohol use are associated with hand OA features.

Methods: We included 530 persons from the Musculoskeletal pain in Ullensaker study (MUST), Norway (mean (SD) age 65 (8.0) years and 71% females) with radiographic hand OA in 1 or more joints and no inflammatory joint diseases. The participants were grouped into three categories based on their self-reported smoking status; Current (daily), former (quit > 6 months ago) and never smokers. Persons reporting to consume alcohol daily, weekly or monthly were categorized as drinkers. Conventional hand radiographs were obtained, and the number of finger joints with radiographic OA (Kellgren-Lawrence grade 2 or more) was calculated (0-30 scale). Participants having one or more joint(s) with ultrasound-detected grey-scale synovitis were classified as having inflammatory OA. We studied the associations between smoking and alcohol (as the independent variables) and the severity of radiographic OA, AUSCAN pain and presence of inflammatory OA (as the dependent variables), using linear and logistic regression analyses. Separate models were performed for smoking and alcohol. Analyses were adjusted for age, sex and education status. 

Results: Current smoking was significantly associated with fewer joints with radiographic OA independent of age, sex and education status (Table 1). There was also a trend that former smoking was related to less radiographic hand OA, but the association was not statistically significant in the adjusted analyses. Being a drinker was significantly associated with inflammatory OA in the adjusted analyses (Table 1). Neither smoking nor alcohol use were associated with increased hand pain (data not shown). Additional adjustment for alcohol use and smoking in respective sensitivity analyses did not attenuate the results. 

Conclusion: Our results suggest a protective effect of smoking on radiographic hand OA whereas alcohol consumption may increase the risk of joint inflammation in hand OA. Future longitudinal studies are needed to explore the causal associations.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/smoking-and-alcohol-use-are-associated-with-structural-and-inflammatory-hand-osteoarthritis-features-in-a-population-based-study/