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Neuromuscular and cartilage recovery following smoking cessation in knee osteoarthritis

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Created On: 04/07/2026

Smoking is linked with systemic inflammation, impaired musculoskeletal health, and accelerated functional decline.

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Key take away

Quitting smoking promotes functional recovery and enhances neuromuscular and cartilage integrity in knee osteoarthritis.

Background

Smoking is linked with systemic inflammation, impaired musculoskeletal health, and accelerated functional decline. However, the extent to which smoking cessation can reverse these adverse effects in individuals with knee osteoarthritis (OA) remains unclear. This study investigated whether quitting smoking could improve clinical outcomes, physical and respiratory performance, and biomarkers reflecting neuromuscular junction (NMJ) integrity and cartilage degradation over a one-year period.

Method

This prospective one-year longitudinal study enrolled 118 patients with knee OA, including 57 individuals who quit smoking (quitters) and 61 active smokers. Disease severity was assessed using the Oxford Knee Score (OKS). Additional evaluations included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), handgrip strength, gait speed, maximal inspiratory pressure (MIP), and maximal expiratory pressure (MEP). Plasma concentrations of C-terminal agrin fragment-22 (CAF22), a marker of NMJ disruption, and C-telopeptide of type II collagen (CTX-II), a marker of cartilage degradation, were measured via standardized protocols and validated assessment tools.

Result

The study included 57 smoking quitters and 61 active smokers with knee OA. Over 1 year, quitters experienced noticeable improvements in OKS, WOMAC, gait speed, handgrip strength, and MIP compared with active smokers (all p < 0.05). Disease severity distribution improved among quitters, with more patients transitioning from severe to mild OA categories, whereas active smokers showed worsening severity. Smoking cessation was also linked with reductions in CAF22 and CTX-II levels, indicating improved neuromuscular junction integrity and reduced cartilage degradation. Regression analyses demonstrated strong associations between biomarker concentrations, disease severity, and functional outcomes.

Conclusion

Patients who stopped smoking demonstrated improved OA symptoms, enhanced mobility and strength, and healthier biomarker profiles, highlighting the potential benefits of smoking cessation in disease management.