Biomedical subjects

D J Hart

Publications and source records attributed to D J Hart.

At least 55 records · Page 3Linked to original sources

PubMed1996

Association of pain with radiological changes in different compartments and views of the knee joint.

The aim of this study was to examine the association between radiological patellofemoral and tibiofemoral osteoarthritis and knee symptoms in a population-based survey. Two hundred and fifty unrelated, normal individuals (500 knees) were included in the study. Anteroposterior (AP), lateral and skyline radiographs on each individual were graded for joint space narrowing and osteophytes using a standard atlas. Radiographic features were assessed on their ability to predict knee pain for 15 or more days in the last month, the last year or pain "ever'. The presence of osteophytes had the strongest association with knee pain "ever' with an odds ratio (95% Cl) for skyline osteophytes of 7.56 (3.84-14.81) and anteroposterior osteophytes of 5.00 (2.40-10.43). The presence or absence of joint space narrowing in all the radiological views (AP, lateral and skyline) was not significantly associated with knee pain, but there was a trend for an association with severity of narrowing in the lateral and skyline views. The presence of osteophytes in all knee views (AP, lateral or skyline) was best at predicting knee pain in the last year. Osteophytes predict pain more accurately than narrowing on all knee radiographic views (AP, lateral or skyline). Pain in the last year (defined as two or more episodes of pain, each lasting for at least 15 days and not related to recent trauma) is predicted more accurately than pain in the last month or ever having had an episode of knee pain and is a useful symptom for inclusion in population studies.

Arthralgia↗

PubMed1996

The correlation between the intake of lutein, lycopene and beta-carotene from vegetables and fruits, and blood plasma concentrations in a group of women aged 50-65 years in the UK.

The correlations between the mean of 4 d weighed intakes of lutein, lycopene and beta-carotene and mean plasma concentrations during each of the four seasons were lutein r 0.64, lycopene r 0.47 and beta-carotene r 0.45. Intake was not significantly correlated with plasma concentrations during every seasonal time-point. There was a significantly higher intake of lutein during the spring compared with summer and autumn, lycopene intake was significantly higher during the summer and autumn and there were no significant seasonal differences in beta-carotene intake. There were, however, significant seasonal differences in plasma carotenoid concentrations, the highest levels occurring between May and October. There were large inter- and intra-individual variations in intake and plasma concentrations of carotenoids. BMI was inversely correlated with plasma beta-carotene (r-0.41). The findings suggest that plasma carotenoid concentrations are indicative of dietary intake, but the large intra-individual variation in plasma concentrations indicates that any assessment of longer-term status from data at any one time-point should be treated with caution.

Aged↗

PubMed1996

The association between osteoarthritis and osteoporotic fracture: the Chingford Study.

Studies of the association between the presence of osteoarthritis (OA) and the risk of osteoporotic fractures have produced conflicting results. To address this question further, we have examined the association between self-reported, validated fractures and radiological OA at multiple sites in a large population of normal Caucasian women aged 45-65 yr. Despite having increased bone mineral density (BMD) of 5.3%, subjects with hip OA had a significantly increased risk of fracture [odds ratio (OR) 2.38, 95% CI 1.06-5.35] compared to controls. Subjects with lumbar spine OA, however, had a significantly reduced risk of fracture (OR 0.45, 95% CI 0.23-0.80) compared to controls. This association was not explained by differences in BMD, weight, sex hormones or physical activity. No clear association was seen with fracture for hand or knee OA. These data suggest that the increased risk of fracture in subjects with OA of the hip is most likely to be due to mechanical and locomotor factors, such as the risk of falling.

Body Weight↗

PubMed1996

Relation between insulin-like growth factor-I concentrations, osteoarthritis, bone density, and fractures in the general population: the Chingford study.

OBJECTIVE: To assess the association between serum insulin-like growth factor-I (IGF-1) concentrations and osteoarthritis, and bone mineral density, and fractures in a large group of middle aged women from the general population. METHODS: 761 women aged 44-64 years from the Chingford study had serum IGF-I concentrations measured; hand, hip, spine, and anteroposterior weight bearing knee radiographs taken; and dual energy x ray absorptiometry (DEXA) scans of the hip and spine. X rays were scored using the Kellgren and Lawrence system. In addition knee x rays were scored using a standard atlas for individual features of osteophytes and joint space narrowing (both graded 0-3). IGF-I concentrations were adjusted for the effects of age. RESULTS: In the osteoarthritis analysis results were compared to a constant group of 155 subjects with no evidence of osteoarthritis at any site. There was no significant difference in serum IGF-I between these subjects and 606 subjects with osteoarthritis at any site. When individual sites were analysed, serum IGF-I was higher in those cases with more severe bilateral knee osteoarthritis and in those with distal interphalangeal (DIP) joint disease. There was no significant association between serum IGF-I and other forms of osteoarthritis or milder forms of knee osteoarthritis. There was no correlation between IGF-I concentrations and bone mineral density at the spine or hip, nor any difference between IGF-I concentrations in subjects with and without a history of non-traumatic fracture [22.8 (SD 6.6) v 23.1 (SD 6.6) nmol litre-1, P = 0.6] CONCLUSIONS: There is a modest association between IGF-I concentrations and the development of DIP osteoarthritis and more severe or bilateral knee joint osteoarthritis in women from the normal population, but no association with other forms of osteoarthritis, bone density, or fractures.

Absorptiometry, Photon↗

PubMed1996

Spiking of the tibial tubercles--a radiological feature of osteoarthritis?

OBJECTIVE: To determine whether 'spiking' or angulation of the tibial tubercle is associated with other radiographic markers of osteoarthritis (OA) or pain in the knee joint, and could be taken as a reliable marker for early OA, in a large general population sample. METHODS: A total of 950 women from the Chingford general population survey underwent anteroposterior extended weight bearing radiography of the knees. Angulation of the tip of the medial and lateral tubercles, and height of the tubercles above the tibial plateau were measured. These measures were compared with standard radiographic indices including qualitative Kellgren and Lawrence global score, individual scores of osteophytes and joint space narrowing, and pain score. Intraobserver and interobserver reproducibility for assessment of spiking was tested in a subgroup of 50 films using two observers and two readings. Tibial spiking (angulation and height) was defined for this study as the top 10th centile for the whole population. Patients with normal radiographs (Kellgren and Lawrence grade 0) were allocated to quartile groups on the basis of spiking to define severity. Odds ratios were then calculated for the association of spiking and knee pain. RESULTS: The majority of the measures of tibial spiking were highly reproducible. There was a significant correlation between tibial spike angulation and the presence of osteophytes, but not joint space narrowing. The correlations for spike height with osteophytes and joint space narrowing were poor. There was an association between spike angulation at the lateral tubercle and reported knee pain (odds ratio 1.45 (95% confidence interval 1.03 to 2.03)) after adjustment for age, body mass index, and Kellgren and Lawrence score. There was no association between medial spike angulation or spike height and pain. Among the 950 women, 683 (72%) had normal radiographs (Kellgren and Lawrence = 0); in this group there was a similar association between pain and lateral spike angulation, but not medial spike angulation or spike height. CONCLUSIONS: Tibial spiking is associated with the presence of knee osteophytes and is reproducible, but does not have a strong independent relationship with knee pain. In patients with normal radiographs there is no useful correlation between tibial spiking and pain. Isolated tibial spiking is not a reliable sign of early knee OA, and should not routinely be reported.

Aged↗

PubMed1996

Choosing the best method for radiological assessment of patellofemoral osteoarthritis.

OBJECTIVE: To assess the reproducibility of different methods of radiological assessment of patellofemoral osteoarthritis (OA) and to determine which is the best view as a research tool in epidemiological studies of knee OA requiring explicit diagnostic criteria to classify the disease in the general population. METHODS: A population based study of 252 unrelated, normal individuals (504 knees) was performed. Lateral and skyline radiographs from each individual were graded for joint space narrowing and osteophytes using a standard atlas. Reproducibility was assessed by two observers on 50 knees. Radiographic features were assessed on their ability to predict knee pain. RESULTS: The skyline views performed better than the lateral views in the assessment of patellofemoral joint OA. The reproducibility for osteophytes was high (kappa > 0.8) and that for joint space narrowing moderate (kappa > 0.6) for both lateral and skyline views. Although the specificity for detecting knee pain was similar in both views, the sensitivity of skyline views in the assessment of knee pain was greater (52.8% versus 30%). The odds ratio for skyline osteophytes as a predictor of knee pain was 7.66 (95% confidence interval (CI) 3.68 to 15.90); that for osteophytes seen on lateral view was 1.83 (95% CI 0.96 to 3.49). Narrowing on both views was a poor predictor of pain. There was frequent disagreement between the lateral and skyline views for detecting osteophytes. CONCLUSION: In a community based study, skyline views performed better than lateral views in terms of reproducibility and for identifying symptomatic patellofemoral joint OA. Skyline radiographs should be the preferred method for examining the patellofemoral joint in such studies.

Female↗

PubMed1996

Generalized osteoarthritis in women: pattern of joint involvement and approaches to definition for epidemiological studies.

OBJECTIVE: To ascertain whether clustering between joint sites in osteoarthritis (OA) is more common than would be expected simply from the rising prevalence of the disorder with age, and to explore a definition of generalized OA (GOA) by determining the pattern of joint group involvement, in a population sample of peri and postmenopausal women. METHODS: Radiographs of the hands, knees, and hips were obtained in a population sample of 702 women aged 45 to 64 years. Distal interphalangeal, proximal interphalangeal, carpometacarpal, knee, and hip OA were assessed using the Kellgren-Lawrence grading system. Logistic regression was used to test for overall clustering of OA between joint sites, and log linear models were used to study the patterns of association between different sites. RESULTS: Multiple involvement of the 5 joint groups studied occurred significantly more frequently than could be expected by chance alone (chi 2 = 52.3, df = 5, p < 0.001), and this clustering remained significant after age adjustment (chi 2 = 26.1, df = 5, p < 0.001). Thresholds could be defined for the number of involved joint groups that distinguished a polyarticular subset of OA. These thresholds varied with age and the radiographic cutoff at which OA was assigned. Thus, for grade 2+ disease, GOA could be defined by involvement of 2 or more joint groups at age 45-47 years, but required involvement of all 5 joint groups at age 60-64 years. Symmetry within joint groups was the most pronounced feature in the pattern of joint involvement in the sample as a whole, with associations between different joint groups being substantially weaker than those for symmetrical bilateral involvement of a particular joint. CONCLUSION: There is a clear tendency towards polyarticular OA among women aged 45-64 years. However, there is no single threshold number of joint sites that can be used to define GOA. The pattern of joint involvement in OA is primarily symmetrical, and this pattern strongly suggests a systemic etiology in this subset of postmenopausal women.

Arthrography↗

PubMed1995

The classification and assessment of osteoarthritis.

Osteoarthritis is the commonest rheumatic disease, but despite its high prevalence in the elderly, associated disability and public health costs, there is little understanding of the aetiology of the disease. Questions still remain unanswered: 'what do we mean by the term osteoarthritis?; how do we define it?; how do we classify patients with the disease?; how do we differentiate between cases for population studies, and clinically relevant disease the physician wishes to treat?'. This chapter has demonstrated the considerable advances that have been made over the last thirty years in solving these issues, but we are still lacking a universal definition and classification of the disease. Defining and classifying OA is not an easy task, as it is not a single disease, but rather a spectrum of diseases that are the end result of a number of different processes. However, in order to understand the aetiology and natural course of the disease, and to devise appropriate treatment strategies, correct definition of OA at distinct sites is vital. Radiological site-specific definition of the disease is now recognized as the major tool available in defining OA. There is general consensus that the grading of osteophytes and joint space narrowing at the major sites using validated atlases is an important step forward.

Arthrography↗

PubMed1995

Patterns of joint involvement in osteoarthritis of the hand: the Chingford Study.

OBJECTIVE: The hand is the major site of joint involvement in osteoarthritis (OA), but the clustering of this condition at different joint sites within the hand as part of an entity known as generalized OA remains contentious. We examine this issue in a population sample of 967 peri and postmenopausal women. METHODS: The pattern of radiographic involvement of hand joints was examined using the Kellgren and Lawrence system in a sample of women aged 45-64 years, selected from the general population in Chingford, East London. Log linear modelling techniques were used to examine clustering of OA in different joint sites and to examine whether this clustering remained significant after age adjustment. RESULTS: There was clear evidence of clustering in joint involvement: Thus 20 women had 4 or more affected joints compared with only 2 expected (chi 2 = 72.0, 4df, p < 0.001). The risk of multiple distal interphalangeal (DIP) joint involvement, after age adjustment, in a woman with a single affected DIP joint was significantly increased (OR 10.0, 95% CI 7.3-13.7) and was substantially greater than the corresponding risk for proximal interphalangeal joint (OR 3.1, 95% CI 1.4-6.8) involvement. Symmetry was the strongest determinant of pattern with an OR 38.8 (95% CI 14.5-103.5) for corresponding DIP joint involvement in the contralateral hand. CONCLUSION: These data provide clear evidence for a polyarticular subset of hand OA in women. There are 3 major determinants of the pattern of polyarticular involvement; symmetry, clustering by row and clustering by ray, in descending order of importance.

Female↗

PubMed1995

Association between metabolic factors and knee osteoarthritis in women: the Chingford Study.

OBJECTIVE: Several studies have shown an association with density and knee osteoarthritis (OA), however the role of other metabolic factors is unclear, with conflicting data in the literature. We studied the association between metabolic risk factors and k nee OA in women in the general population. METHODS: One thousand three women aged 45-64 from the Chingford population study completed risk factor questionnaires. Current blood pressure and ever hypertension were noted and fasting blood glucose, serum cholesterol, triglycerides, high density lipoprotein( HDL), and uric acid levels were measured. AP weight bearing radiographs were available in 979 women and scored using the Kellgren and Lawrence system. Grade 2+ (definite osteophytes) was used a definition of knee OA. Odds ratios (OR) and 95% confidence intervals were calculated for risk of knee OA in highest tertile versus lowest for death risk factor. All OR were adjusted for age and body mass index as potential confounders for OA. RESULTS: Radiological evidence of knee OA was found in 118 women (12%). For knee OA in either knee the variables significantly associated were raised blood glucose OR = 1.95 (1.08-3.59), and moderately raised serum cholesterol OR = 2.06 (1.06-3.98). For symptomatic women (n = 58) raised blood glucose OR = 2.77 (1.13-6.76), and use of diuretics OR = 2.27 (1.11-4.65) were significantly associated. For bilateral knee disease (n = 55) significant associations were found for ever hypertension OR = 3.02 (1.51-6.06), subjects taking diuretics OR = 2.84 (1.37-5.89), and both high and moderately raised serum cholesterol OR = 3.91 (1.07-14.25), and OR = 3.63 (1.00-13.88), respectively. In all categories of knee OA serum uric acid was nonsignificantly increased. No association was found with raised triglyceride or HDL levels or with current systolic blood pressure. Further adjustment for physical activity and social class did not affect the results. CONCLUSION: These data suggest that hypertension, hypercholesterolemia, and blood glucose are associated with both unilateral and bilateral knee OA independent of obesity, and support the concept that OA has an important systemic and metabolic component in its etiology.

Body Mass Index↗

PubMed1995

Radiographic criteria for epidemiologic studies of osteoarthritis.

For the purpose of epidemiologic studies in osteoarthritis (OA) an agreed criteria set is required that is both reliable and reproducible. A standardized method of radiologic classification will promote better reporting of epidemiologic data and consistency between centers. The radiographic scoring system of Kellgren and Lawrence has been used in OA research for over 30 years. Its deficiencies include the lack of clarity in interpretation and its reliance on the presence of the osteophyte. Recent advances suggest other pathological evidence of OA on radiographs should be measured when assessing OA. There is growing consensus that while a global score is still useful, the separate features should be recorded in a semiquantitative fashion using standardized atlases allowing different emphasis of particular features at different sites.

Guidelines as Topic↗

PubMed1994

The progression of radiological hand osteoarthritis over ten years: a clinical follow-up study.

The natural history of hand osteoarthritis (OA) is poorly understood. The aim of the study was to ascertain the extent and pattern of radiological progression of hand OA over a 10-year period. A follow-up study was carried out on 169 consecutive patients who initially presented with OA of the hands or knees between 1975-1977. Fifty-nine subjects (45 women and 14 men) were recontacted who had paired hand radiographs, a mean of 10 years apart, and were a mean 69 (range 53-86) years old at follow-up. X-rays were scored blind, in three joint areas--distal and proximal interphalangeal joints (DIP and PIP) and first carpo-metacarpal (CMC) joints--using the method of Kellgren and Lawrence (K&L) (0-4), and for osteophytes and narrowing (0-3). Using the highest score for right and left hands (N = 118), K&L changes at the three areas were similar with 47-50% deteriorating, 45-46% unchanged, and 6-8% improving. Similar deterioration was seen when scoring the three joint areas for osteophytes (38-39%) and narrowing (39-48%). New osteophytes appeared in 48% of DIP joints during the 10 years. There was a weak correlation between progression at the DIP and PIP joints, but no relationship between DIP and CMC, or CMC and PIP. Virtually all subjects (97%) deteriorated when the total scores of all joints were calculated. No significant differences were seen between 'severe progressors' and 'minor' in terms of age or body mass index (BMI). A nonsignificant increase in the proportion of knee progressors in the severe progressor hand group was seen and there was a higher rate of baseline DIP OA in knee progressors. These results suggest that the majority of patients with OA of the hands attending a rheumatology outpatients clinic deteriorate radiologically over a 10-year period, about half developing new changes in DIP joints. There were no obvious features distinguishing those with rapid deterioration, although DIP OA appears to be a risk factor for knee progression.

Aged↗

PubMed1994

The relationship between osteoarthritis and osteoporosis in the general population: the Chingford Study.

OBJECTIVE: A total of 979 women from the Chingford general population survey were studied to examine the hypothesis that osteoarthritis (OA) and osteoporosis are inversely related. METHODS: All women had radiographs of the hands and knees. A total of 579 also had AP radiographs of the lumbar spine which were graded for the presence of osteophytes. All women had bone densitometry performed at the lumbar spine (L1-L4) and femoral neck. Mean bone densities (BMD) were compared between those with disease and those with no disease at any other sites. All results were adjusted for age and body mass index (BMI). RESULTS: All OA groups had significantly higher bone density than controls at the lumbar spine. For distal interphalangeal (DIP) OA (n = 140) the difference was +5.8% (+3.0, +8.6), for carpometacarpal (CMC) OA (n = 160) +3.0% (+0.1, +5.9), for knee OA (n = 118) +7.6% (+4.3, +10.9), and lumbar spine OA (LSOA) (n = 194) +7.8% (+6.0, +8.8). Those with generalised OA (GOA n = 22), a combination of knee, DIP and CMC OA had an increase of +9.3 (+2.0, +16.6). For the femoral neck BMD was also increased significantly ranging from +2.5% for the CMC, +6.2% for the knee and +6.3% in the lumbar spine OA group. The risk of knee OA for women in the top tertile of BMD was 2.13 (1.15-3.93). Additional adjustment for other confounders such as smoking, alcohol, exercise, HRT, social class and spine osteophytes did not alter the results. CONCLUSIONS: These results suggest that small increases in BMD are present in middle aged women with early radiological OA of the hands, knees and lumbar spine. These data support the hypothesis that the two conditions are inversely related, although the mechanisms remain unclear.

Bone Density↗

PubMed1994

Incidence and progression of osteoarthritis in women with unilateral knee disease in the general population: the effect of obesity.

OBJECTIVES: The natural history of knee osteoarthritis (OA) is poorly understood. The principal aim was to assess the rate of contralateral knee OA in middle aged women in the general population with existing unilateral disease and to identify the major factors that influence this rate. METHODS: Fifty eight women aged (45-64) from a general population study cohort were identified with unilateral knee OA diagnosed radiologically (Kellgren and Lawrence 2+) (K&L). Follow up AP films were obtained at 24 months and compared with the baseline for K&L grade and individual features of osteophytes and joint space. RESULTS: Twenty women (34%) developed incident disease in the contralateral knee (based on K&L 2+ or osteophyte changes) and 22.4% (n = 13) of women progressed radiologically in the index joint. Obesity at baseline was the most important factor related to incident disease, 47% of women in the top BMI tertile developed OA, compared with 10% in the lowest tertile: relative risk 4.69 (063-34.75). No clear effect was seen for age, physical activity, trauma or presence of hand OA. CONCLUSIONS: Over one third of middle aged women with unilateral disease will progress to bilateral knee OA within two years and a fifth will progress in the index joint. Obesity is a strong and important risk factor in the primary and secondary prevention of OA. These natural history data provide a useful estimate for planning therapeutic intervention trials.

Body Mass Index↗

PubMed1994

Primary biliary cirrhosis presenting with granulomatous skin lesions.

A case is described of primary biliary cirrhosis in a 59 year old woman who initially presented with a rash over her lower legs 18 months before diagnosis. Skin biopsy examination showed non-caseating granulomas of the sarcoid type. It is believed that this is the first reported case of primary biliary cirrhosis presenting with a granulomatous rash.

Female↗

PubMed1993

Increased levels of urinary collagen crosslinks in females with rheumatoid arthritis.

Bone loss is a feature of RA, but the exact mechanisms involved are not clear. The collagen crosslinks deoxypyridinoline (DPYR) and pyridinoline (PYR) are specific indices of 'mature' collagen breakdown and reflect increased bone turnover. The aims of the study were to examine crosslink levels in RA and their association with disease activity and the effect of steroids. Urinary crosslinks corrected for creatinine were measured on morning fasting samples by HPLC in 70 postmenopausal women with rheumatoid arthritis (RA) aged 45-65 and compared with 169 postmenopausal healthy age-matched controls from the population. Mean levels of PYR were significantly higher in RA cases than in controls (52.4 versus 37.5 nmols/mmolCr) although mean levels of DPYR did not differ significantly. A weak correlation was found with ESR and PYR (r = 0.35) but not with other markers of disease activity. Thirteen of the RA cases were current steroid users and their levels of DPYR and PYR even with low doses, were significantly elevated above those of non-users, ex-users and controls. The finding of raised urinary PYR but not the bone specific DPYR in nonsteroid using RA cases suggests that the increased collagen breakdown does not primarily come from bone but from other sources such as cartilage and synovium. The large increases in collagen excretion in low dose steroid users, may reflect the higher risk of osteoporosis in this group.

Aged↗

PubMed1993

Definition of osteoarthritis of the knee for epidemiological studies.

OBJECTIVES: There are no agreed criteria for osteoarthritis (OA) of the knee in population studies. The radiographic scoring system of Kellgren and Lawrence has been the system most used in the past and although other methods have been developed, comparisons have not been performed. Therefore these grading systems were compared in radiographs from a general population sample. METHODS: Anteroposterior weightbearing radiographs of 1954 knees from 977 women aged 45-64 years from the Chingford population study were read by a variety of methods, including quantitative measures of minimum joint space, qualitative measures of osteophytes and of joint space, and a qualitative Kellgren and Lawrence global score. All qualitative methods used standardised atlases. Intra-observer and interobserver reproducibility was tested on a subgroup of 100 films using three observers and two readings. Variables were dichotomised at the tenth and second centiles to define OA. Odds ratios were calculated for each method for the association of OA with knee pain, obesity, and with each of the other methods. RESULTS: Most methods had high intraobserver and interobserver reproducibility, except for measurements of lateral joint space. The best predictors of knee pain were the presence of osteophytes and the Kellgren and Lawrence grade. Methods measuring narrowing performed less well, with measurements of lateral joint space being particularly poor. Similar results were achieved in the comparison with obesity and in the comparisons between methods. CONCLUSIONS: These data suggest that the presence or absence of a definite osteophyte read by a single observer with an atlas is the best method of defining OA of the knee for epidemiological studies in women. Assessment of narrowing may be better used in evaluating severity.

Bone and Bones↗

PubMed1993

Cigarette smoking and risk of osteoarthritis in women in the general population: the Chingford study.

Previous studies have suggested that smoking might be protective against the development of osteoarthritis (OA) of the knee. A group of 1003 women aged 45-64 years (mean 54.2 years) from the Chingford general population survey were studied to examine the effect of cigarette smoking on the prevalence of radiologically confirmed OA at different sites. Standard anteroposterior radiographs of the hand and knee were available in 985 women. Disease classification was made on the basis of radiological OA and symptomatic radiological OA. Odds ratios were calculated and adjusted for age and body mass index. A total of 463 (46.2%) women were ever smokers compared with 540 (53.8%) non-smokers. Ever smokers had consumed an average of 14.9 cigarettes a day for a mean of 25.7 years. For radiological OA of the distal interphalangeal joint (DIP) (140 women), proximal interphalangeal joint (40 women), carpometacarpal joint (160 women), and knee joint (118, women) there was no reduced risk of OA in ever smokers. In the small number of subjects with generalised OA (22 women) there was a non-significant 40% reduction of radiological OA in ever smokers (odds ratio 0.63; 95% confidence interval 0.24 to 1.68). Results were similar for subjects with radiographic clinical OA, except the DIP joint which showed a positive association between smoking and Heberden's nodes (odds ratio 2.02, 95% confidence interval 1.89 to 3.42). Results were similar when analysed using current smokers against never smokers. These results do not support an inverse association between cigarette smoking and OA in women. A possible inverse relation with the small subgroup of women with generalised OA and an effect of cigarettes on disease severity cannot, however, be discounted.

Arthrography↗