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In this Perspective, we discuss the current evidence on the smokingOA association and examine how both conventional cigarette smoke and EC aerosol may contribute to OA through six interrelated immune-inflammatory pathways: exposure-specific effects, synovial macrophage activation, DAMP-mediated nuclear factor kappa-B (NF-B) signaling, inflammasome activation, T helper cell 17 (Th17)/regulatory T cell (Treg) imbalance, and microRNA (miRNA) dysregulation

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"We got advice sort of 12 to 18 months ago that that steady reduction that we'd seen over the course of 30 years had started to stagnate, and that was in part a product of the lack of any real change in tobacco control," Mr Butler told 7.30