{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T04:02:05Z","timestamp":1781668925701,"version":"3.54.5"},"reference-count":54,"publisher":"BMJ","issue":"3","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2016,2,11]]},"published-print":{"date-parts":[[2016,3]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>High-sensitivity C-reactive protein (hsCRP) is possibly related to osteoarthritis (OA) progression and a variety of OA-related symptoms. This study aimed to examine associations between cigarette smoking, betel quid chewing and alcohol consumption and hsCRP in early radiographic knee OA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Cross-sectional health examination survey.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>This primary study was conducted in a health examination centre in China.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>936 (656 men and 280 women) patients with early radiographic knee OA were included in this cross-sectional study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary and secondary outcome measures<\/jats:title>\n                    <jats:p>Smoking status was classified into four levels based on daily smoking habit: 0\/day, 1\u201310\/day, 11\u201320\/day and &gt;20\/day. Betel quid chewing and alcohol consumption status was divided into \u2018Yes\u2019 or \u2018No\u2019. Early radiographic knee OA was defined as Kellgren Lawrence (K-L) grade 1 or 2 in at least one leg, and elevated hsCRP was assessed as \u22653.0\u2005mg\/L.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>After adjustment for a number of potential confounding factors, a significant positive association between cigarette smoking and hsCRP was observed in the multivariable model. The multivariable-adjusted ORs (95% CI) of elevated hsCRP (\u22653.0\u2005mg\/L) in the second (1\u201310\/day, n=133), third (11\u201320\/day, n=59) and highest (&gt;20\/day, n=104) cigarette smoking categories were 1.54 (95% CI 0.91 to 2.61), 1.27 (95% CI 0.57 to 2.79) and 2.09 (95% CI 1.20 to 3.64), respectively, compared with the non-smoker category (n=640). In addition, there was a positive dose\u2013response relationship between cigarette smoking and elevated hsCRP (p for trend=0.01). No significant associations between betel quid chewing and alcohol consumption and hsCRP were observed in the multivariable model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This study indicated that cigarette smoking was positively associated with serum hsCRP level in patients with early radiographic knee OA. However, in view of the nature of cross-sectional designs, the results need to be confirmed by further prospective studies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2015-010763","type":"journal-article","created":{"date-parts":[[2016,3,11]],"date-time":"2016-03-11T22:54:56Z","timestamp":1457736896000},"page":"e010763","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":11,"title":["Associations of cigarette smoking, betel quid chewing and alcohol consumption with high-sensitivity C-reactive protein in early radiographic knee osteoarthritis: a cross-sectional study"],"prefix":"10.1136","volume":"6","author":[{"given":"Yi","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chao","family":"Zeng","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jie","family":"Wei","sequence":"additional","affiliation":[{"name":"Health Management Center, Xiangya Hospital, Central South University, Changsha, Hunan Province, China"},{"name":"Department of Epidemiology and Health Statistics, School of Public Health, Central South University, Changsha, Hunan Province, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tuo","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ye","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhen-han","family":"Deng","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiang","family":"Ding","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guanghua","family":"Lei","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2016,3,11]]},"reference":[{"key":"2025121601353913000_6.3.e010763.1","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/keh344"},{"key":"2025121601353913000_6.3.e010763.2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(14)60802-3"},{"key":"2025121601353913000_6.3.e010763.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2005.06.017"},{"key":"2025121601353913000_6.3.e010763.4","doi-asserted-by":"publisher","DOI":"10.1002\/jcla.1860060106"},{"key":"2025121601353913000_6.3.e010763.5","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2013-204494"},{"key":"2025121601353913000_6.3.e010763.6","doi-asserted-by":"publisher","DOI":"10.1002\/art.1780400419"},{"key":"2025121601353913000_6.3.e010763.7","doi-asserted-by":"publisher","DOI":"10.1177\/1759720X12455959"},{"key":"2025121601353913000_6.3.e010763.8","doi-asserted-by":"crossref","first-page":"R123","DOI":"10.1186\/ar4580","article-title":"Elevated C-reactive protein is associated with lower increase in knee muscle strength in patients with knee osteoarthritis: a 2-year follow-up study in the Amsterdam Osteoarthritis (AMS-OA) cohort","volume":"16","author":"Sanchez-Ramirez","year":"2014","journal-title":"Arthritis Res Ther"},{"key":"2025121601353913000_6.3.e010763.9","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(12)61085-X"},{"key":"2025121601353913000_6.3.e010763.10","doi-asserted-by":"publisher","DOI":"10.1080\/13556210020091437"},{"issue":"4","key":"2025121601353913000_6.3.e010763.11","doi-asserted-by":"crossref","first-page":"31","DOI":"10.47102\/annals-acadmedsg.V33N4p31S","article-title":"Epidemiology of betel quid usage","volume":"33","author":"Gupta","year":"2004","journal-title":"Ann Acad Med Singap"},{"key":"2025121601353913000_6.3.e010763.12","doi-asserted-by":"crossref","first-page":"1136","DOI":"10.1186\/1471-2458-13-1136","article-title":"The association between hyperuricemia and betel nut chewing in Taiwanese men: a cross-sectional study","volume":"13","author":"Tai","year":"2013","journal-title":"BMC Public Health"},{"key":"2025121601353913000_6.3.e010763.13","doi-asserted-by":"publisher","DOI":"10.1080\/14622200801901997"},{"key":"2025121601353913000_6.3.e010763.14","doi-asserted-by":"publisher","DOI":"10.1007\/s10654-007-9121-6"},{"key":"2025121601353913000_6.3.e010763.15","first-page":"3","article-title":"[C-reactive protein value related to a smoking history and composition of nicotine and tobacco tar]","volume":"23","author":"Martin","year":"2006","journal-title":"An Med Interna"},{"key":"2025121601353913000_6.3.e010763.16","doi-asserted-by":"publisher","DOI":"10.1016\/j.ypmed.2005.02.002"},{"key":"2025121601353913000_6.3.e010763.17","doi-asserted-by":"crossref","first-page":"1211","DOI":"10.1007\/s00296-014-3202-0","article-title":"Relationship between cigarette smoking and radiographic knee osteoarthritis in Chinese population: a cross-sectional study","volume":"35","author":"Zhang","year":"2015","journal-title":"Rheumatol Int"},{"key":"2025121601353913000_6.3.e010763.18","doi-asserted-by":"publisher","DOI":"10.1016\/j.joca.2014.03.013"},{"key":"2025121601353913000_6.3.e010763.19","doi-asserted-by":"publisher","DOI":"10.1002\/art.30400"},{"key":"2025121601353913000_6.3.e010763.20","doi-asserted-by":"crossref","first-page":"262","DOI":"10.1186\/1471-2474-14-262","article-title":"Smoking and primary total hip or knee replacement due to osteoarthritis in 54,288 elderly men and women","volume":"14","author":"Mnatzaganian","year":"2013","journal-title":"BMC Musculoskelet Disord"},{"key":"2025121601353913000_6.3.e010763.21","doi-asserted-by":"publisher","DOI":"10.1007\/s10654-005-4263-x"},{"key":"2025121601353913000_6.3.e010763.22","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/32.5.366"},{"key":"2025121601353913000_6.3.e010763.23","doi-asserted-by":"publisher","DOI":"10.1007\/s00296-007-0356-z"},{"key":"2025121601353913000_6.3.e010763.24","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1186\/s13075-015-0534-4","article-title":"Beer and wine consumption and risk of knee or hip osteoarthritis: a case control study","volume":"17","author":"Muthuri","year":"2015","journal-title":"Arthritis Res Ther"},{"key":"2025121601353913000_6.3.e010763.25","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.0000045669.16499.EC"},{"key":"2025121601353913000_6.3.e010763.26","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.2003.016337"},{"key":"2025121601353913000_6.3.e010763.27","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2006.08.104"},{"key":"2025121601353913000_6.3.e010763.28","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1016\/j.atherosclerosis.2005.11.007","article-title":"C-reactive protein and alcohol consumption: is there a U-shaped association? Results from a population-based study in Russia. The Arkhangelsk study","volume":"188","author":"Averina","year":"2006","journal-title":"Atherosclerosis"},{"key":"2025121601353913000_6.3.e010763.29","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1007\/s12603-010-0042-9","article-title":"The association of age, gender, body fatness and lifestyle factors with plasma C-reactive protein concentrations in older Taiwanese","volume":"14","author":"Tsai","year":"2010","journal-title":"J Nutr Health Aging"},{"key":"2025121601353913000_6.3.e010763.30","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1186\/1476-9255-9-22","article-title":"Areca nut chewing and systemic inflammation: evidence of a common pathway for systemic diseases","volume":"9","author":"Shafique","year":"2012","journal-title":"J Inflamm (Lond)"},{"key":"2025121601353913000_6.3.e010763.31","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1684\/mrh.2015.0384","article-title":"Association between low serum magnesium concentration and hyperuricemia","volume":"28","author":"Zeng","year":"2015","journal-title":"Magnes Res"},{"key":"2025121601353913000_6.3.e010763.32","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.141414"},{"key":"2025121601353913000_6.3.e010763.33","doi-asserted-by":"crossref","first-page":"e0127666","DOI":"10.1371\/journal.pone.0127666","article-title":"Association between dietary magnesium intake and radiographic knee osteoarthritis","volume":"10","author":"Zeng","year":"2015","journal-title":"PLoS ONE"},{"key":"2025121601353913000_6.3.e010763.34","doi-asserted-by":"publisher","DOI":"10.1136\/ard.16.4.494"},{"key":"2025121601353913000_6.3.e010763.35","doi-asserted-by":"crossref","first-page":"1062","DOI":"10.1093\/ajcn\/84.5.1062","article-title":"Dietary magnesium and fiber intakes and inflammatory and metabolic indicators in middle-aged subjects from a population-based cohort","volume":"84","author":"Bo","year":"2006","journal-title":"Am J Clin Nutr"},{"key":"2025121601353913000_6.3.e010763.36","doi-asserted-by":"publisher","DOI":"10.1080\/07315724.2005.10719461"},{"key":"2025121601353913000_6.3.e010763.37","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0091080"},{"key":"2025121601353913000_6.3.e010763.38","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0070533"},{"key":"2025121601353913000_6.3.e010763.39","doi-asserted-by":"crossref","first-page":"424","DOI":"10.2337\/diacare.29.02.06.dc05-2033","article-title":"Association between elevated serum C-reactive protein and triglyceride levels in young subjects with type 1 diabetes","volume":"29","author":"Ladeia","year":"2006","journal-title":"Diabetes Care"},{"key":"2025121601353913000_6.3.e010763.40","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.161.2.264"},{"key":"2025121601353913000_6.3.e010763.41","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2010.142323"},{"key":"2025121601353913000_6.3.e010763.42","doi-asserted-by":"crossref","first-page":"1026","DOI":"10.1002\/acr.21954","article-title":"Does smoking reduce the progression of osteoarthritis? Meta-analysis of observational studies","volume":"65","author":"Pearce","year":"2013","journal-title":"Arthritis Care Res (Hoboken)"},{"key":"2025121601353913000_6.3.e010763.43","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2006.056697"},{"key":"2025121601353913000_6.3.e010763.44","doi-asserted-by":"publisher","DOI":"10.1186\/ar2380"},{"key":"2025121601353913000_6.3.e010763.45","doi-asserted-by":"crossref","first-page":"211","DOI":"10.2217\/bmm.12.112","article-title":"The acute effect of cigarette smoking on the high-sensitivity CRP and fibrinogen biomarkers in chronic obstructive pulmonary disease patients","volume":"7","author":"van Dijk","year":"2013","journal-title":"Biomark Med"},{"key":"2025121601353913000_6.3.e010763.46","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfi052"},{"key":"2025121601353913000_6.3.e010763.47","doi-asserted-by":"crossref","first-page":"171538","DOI":"10.1155\/2014\/171538","article-title":"Mediation role of C-reactive protein on the association between smoking quantity and type 2 diabetes in current Chinese smokers","volume":"2014","author":"Feng","year":"2014","journal-title":"J Diabetes Res"},{"key":"2025121601353913000_6.3.e010763.48","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2003.007674"},{"key":"2025121601353913000_6.3.e010763.49","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2458-12-162"},{"key":"2025121601353913000_6.3.e010763.50","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1186\/1756-0500-3-228","article-title":"Betel nut chewing and incidence of newly diagnosed type 2 diabetes mellitus in Taiwan","volume":"3","author":"Tseng","year":"2010","journal-title":"BMC Res Notes"},{"key":"2025121601353913000_6.3.e010763.51","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1016\/j.kjms.2012.08.037","article-title":"Chewing areca nut as an independent risk factor for proteinuria in middle-aged men","volume":"29","author":"Liu","year":"2013","journal-title":"Kaohsiung J Med Sci"},{"key":"2025121601353913000_6.3.e010763.52","doi-asserted-by":"crossref","first-page":"315","DOI":"10.3109\/08923973.2010.507208","article-title":"Areca-nut extract modulates antigen-specific immunity and augments inflammation in ovalbumin-sensitized mice","volume":"33","author":"Wang","year":"2011","journal-title":"Immunopharmacol Immunotoxicol"},{"key":"2025121601353913000_6.3.e010763.53","doi-asserted-by":"crossref","first-page":"748","DOI":"10.1111\/j.1600-0714.2012.01166.x","article-title":"Betel-quid and oral submucous fibrosis: a cross-sectional study in Hunan province, China","volume":"41","author":"Zhang","year":"2012","journal-title":"J Oral Pathol Med"},{"key":"2025121601353913000_6.3.e010763.54","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0528.1997.tb00918.x"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2015-010763","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,16]],"date-time":"2025-12-16T09:35:50Z","timestamp":1765877750000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2015-010763"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,3]]},"references-count":54,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2016,3,11]]},"published-print":{"date-parts":[[2016,3]]}},"alternative-id":["10.1136\/bmjopen-2015-010763"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2015-010763","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,3]]}}}