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Singh S, Jindal D, Khanna R. Can serum MMP-3 diagnose early knee osteoarthritis? J Orthop 2023; 38:42-46. [PMID: 36969303 PMCID: PMC10034208 DOI: 10.1016/j.jor.2023.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 02/15/2023] [Accepted: 02/22/2023] [Indexed: 03/29/2023] Open
Abstract
Aims This study aims to assess the ability of serum MMP-3 levels to differentiate between normal knee with primary knee osteoarthritis (KOA) and its ability to differentiate between various severity grades. Material & methods The study included 80 cases of primary knee osteoarthritis (KOA) and 80 young individuals with no features of KOA. Results The subjects in Case group were younger (52.80 ± 10.31 years) than in Control group (28.55 ± 5.98 years) (p = 0.001). The BMI of Case group (27.5 ± 4.81 kg/m2) was significantly higher than in Control group (25.40 ± 5.71 kg/m2) (p = 0.012). Mean sMMP-3 level in Cases (59.85 ± 39.92 ng/ml) was significantly higher than in Controls (14.52 ± 6.09 ng/ml) (p = 0.0001). There was no gender difference in biomarker values in Cases (p = 0.1) and in Controls (p = 0.88). The level of sMMP-3 rises with increasing age in cases only (p = 0.0001). MMP-3 values were significantly elevated in cases in the sub-categories of BMI within case group and control group (>0.05) but higher in cases in normal, overweight and obese subcategories (p < 0.05). Serum MMP-3 level differs significantly between K-L grade 0-I (p = 0.004), K-L grade I-II (p = 0.000), K-L grade II-III (p = 0.007) and also between K-L grade III-IV (p = 0.02). Biomarker showed moderate positive correlation with KL grade (r = 0.68, p = 0.000) and age (r = 0.38, p = 0.000) and weak positive correlation with WOMAC score (r = 0.289, p = 0.009). The receiver operative curve (ROC) analysis suggested a cut off value of sMMP-3 as 20.03 ng/ml between Control group and Case group, as 12.25 ng/ml between K-L grade 0-I; as 18.37 ng/ml between K-L grade I-II; as 55.60 ng/ml between K-L grade II-III; as 102.0 ng/ml between K-L grade III-IV. Conclusions sMMP-3 estimation as a tool has a good discriminatory power to differentiate between healthy and a diseased knee (KOA) and between severity grades. It can be used as a test to identify individuals with KL grade I and II of KOA.
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Affiliation(s)
- Sudhir Singh
- Department of Orthopaedics, Teerthankar Mahaveer Medical College & Research Centre, Moradabad, Uttar Pradesh, India
| | - Divyam Jindal
- Department of Orthopaedics, Teerthankar Mahaveer Medical College & Research Centre, Moradabad, Uttar Pradesh, India
| | - Rajat Khanna
- Department of Orthopaedics, Teerthankar Mahaveer Medical College & Research Centre, Moradabad, Uttar Pradesh, India
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Papaneophytou C, Alabajos-Cea A, Viosca-Herrero E, Calvis C, Costa M, Christodoulides AE, Kroushovski A, Lapithis A, Lapithi VM, Papayiannis I, Christou A, Messeguer R, Giannaki C, Felekkis K. Associations between serum biomarkers of cartilage metabolism and serum hyaluronic acid, with risk factors, pain categories, and disease severity in knee osteoarthritis: a pilot study. BMC Musculoskelet Disord 2022; 23:195. [PMID: 35236298 PMCID: PMC8889762 DOI: 10.1186/s12891-022-05133-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 02/15/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Specific serum biomarkers of cartilage metabolism such as cartilage oligomeric matrix protein (sCOMP) and procollagen type II C-terminal propeptide (sPIICP) as well as hyaluronan (sHA), a biomarker of synovitis, have been implicated in the pathophysiology of knee osteoarthritis (OA). However, the associations of these biomarkers with the severity of the disease and OA risk factors, including age and obesity remain inconclusive. This analysis examines the associations between these serum biomarkers and the radiographic severity of OA and knee pain, as wells as obesity, the age and gender of the participants, and other OA risk factors. METHODS From 44 patients with early knee OA and 130 patients with late knee OA we analyzed the radiographic severity of the disease using the Kellgren and Lawrence (KL) grading system. Moreover, 38 overweight healthy individuals were used as a control group. Specific information was collected from all participants during their recruitment. The levels of the three serum biomarkers were quantified using commercially available ELISA kits. Serum biomarkers were analyzed for associations with the average KL scores and pain in both knees, as well as with specific OA risk factors. RESULTS The levels of sCOMP were elevated in patients with severe late OA and knee pain and correlated weakly with OA severity. A weakly correlation of sHA levels and OA severity OA was observed. We demonstrated that only sPIICP levels were markedly decreased in patients with late knee OA suggesting the alterations of cartilage metabolism in this arthritic disease. Moreover, we found that sPIICP has the strongest correlation with obesity and the severity of OA, as well as with the knee pain at rest and during walking regardless of the severity of the disease. ROC analysis showed that the area under the ROC curve (AUC) was 0.980 (95% CI: 0.945-0.995; p < 0.0001), suggesting high diagnostic accuracy of sPIICP. Interestingly, gender and age had also an effect on the levels of sPIICP. CONCLUSION This study revealed the potential of serum PIICP to be used as a biomarker to monitor the progression of knee OA, however, further studies are warranted to elucidate its clinical implication.
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Affiliation(s)
- Christos Papaneophytou
- Department of Life and Health Sciences, School of Sciences and Engineering, University of Nicosia, 2417, Nicosia, Cyprus
| | - Ana Alabajos-Cea
- Physical Medicine & Rehabilitation Department, Hospital La Fe, 46026, Valencia, Spain
- Health Research Institute La Fe, 46026, Valencia, Spain
| | | | - Carme Calvis
- Drug Development Area, Health & Biomedicine Department, LEITAT Technological Centre, Parc Científic de Barcelona, 08028, Barcelona, Spain
| | - Marta Costa
- Drug Development Area, Health & Biomedicine Department, LEITAT Technological Centre, Parc Científic de Barcelona, 08028, Barcelona, Spain
| | | | - Alexander Kroushovski
- Apollonion Hospital, 2054, Nicosia, Cyprus
- Medical School, University of Nicosia, 2408, Nicosia, Cyprus
| | | | | | | | | | - Ramon Messeguer
- Drug Development Area, Health & Biomedicine Department, LEITAT Technological Centre, Parc Científic de Barcelona, 08028, Barcelona, Spain
| | - Christoforos Giannaki
- Department of Life and Health Sciences, School of Sciences and Engineering, University of Nicosia, 2417, Nicosia, Cyprus.
| | - Kyriacos Felekkis
- Department of Life and Health Sciences, School of Sciences and Engineering, University of Nicosia, 2417, Nicosia, Cyprus.
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Zhu J, Ruan G, Cen H, Meng T, Zheng S, Wang Y, Li B, Zhu Z, Han W, Winzenberg T, Wluka AE, Cicuttini F, Wang B, Ding C. Association of serum levels of inflammatory markers and adipokines with joint symptoms and structures in participants with knee osteoarthritis. Rheumatology (Oxford) 2021; 61:1044-1052. [PMID: 34114615 DOI: 10.1093/rheumatology/keab479] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 05/15/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To investigate the longitudinal associations of serum inflammatory markers and adipokines with joint symptoms and structures in participants with knee osteoarthritis (OA). METHODS Two hundred participants (46.5% female, mean age 63.1 years, mean BMI 29.5 kg/m2) from Tasmania part of the VIDEO (Vitamin D Effect on OA) study were randomly selected in the current study. Serum levels of 19 biomarkers, scores of Western Ontario and McMaster Universities Index (WOMAC), and magnetic resonance imaging-assessed knee structures were evaluated at baseline and month 24. The patterns of biomarkers were derived from principal component analysis and their association with knee symptoms and structures were examined using adjusted generalized estimating equations. RESULTS Five components explained 78% of the total variance. Interleukin (IL)-1β, -2, -4, -6, -8, -17A, -17F, -21, -22 and -23 loaded the highest on the first component, which was associated with increased bone marrow lesions (BMLs) and WOMAC dysfunction score. IL-10, -12 and granulocyte-macrophage colony-stimulating factor loaded on the second component, which was associated with increased cartilage volume, and decreased effusion-synovitis and WOMAC scores. Leptin, adipsin and C-reactive protein loaded on the third component, which was positively associated with WOMAC scores. Resistin loaded on the fourth component, which was associated with increased BMLs and cartilage defects. Apelin-36 and adiponectin loaded on the fifth component, which was associated with increased BMLs. CONCLUSION Various inflammatory and metabolic components were associated differently with joint symptoms and structural changes in knee OA, suggesting a complex inflammatory and metabolic inter-relationship in the pathogenesis of knee OA.
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Affiliation(s)
- Jimin Zhu
- Department of Public Health and General Medicine, School of Life Sciences, Anhui University of Chinese Medicine, Hefei, China.,Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Guangfeng Ruan
- Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Han Cen
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.,Department of Preventive Medicine, Medical School, Ningbo University, Ningbo, China
| | - Tao Meng
- Department of Rheumatology and Immunology, The Second Hospital of Anhui Medical University, Hefei, China
| | - Shuang Zheng
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.,Department of Rheumatology and Immunology, Arthritis Research Institute, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yuanyuan Wang
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.,Department of Health Management, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Baikun Li
- Department of Public Health and General Medicine, School of Life Sciences, Anhui University of Chinese Medicine, Hefei, China
| | - Zhaohua Zhu
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.,Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Weiyu Han
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.,Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Tania Winzenberg
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Anita E Wluka
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Flavia Cicuttini
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Binghui Wang
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Changhai Ding
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.,Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, China.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
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Saruga T, Sasaki E, Inoue R, Chiba D, Ota S, Iwasaki H, Uesato R, Nakaji S, Ishibashi Y. Usefulness of serum hyaluronic acid levels as a predictor of incidence of hand osteoarthritis analyzed by longitudinal analysis from the Iwaki cohort. Sci Rep 2021; 11:4074. [PMID: 33603120 PMCID: PMC7892545 DOI: 10.1038/s41598-021-83693-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 02/01/2021] [Indexed: 11/17/2022] Open
Abstract
The factors predicting hand osteoarthritis (HOA) in patients remain unknown. We aimed to investigate the usefulness of serum hyaluronic acid (sHA) levels in predicting HOA progression from a 6-year longitudinal epidemiological study. A total of 417 participants in the Iwaki cohort were followed-up over 6 years. Hand and knee radiographs taken at baseline and follow-up were scored according to Kellgren–Lawrence grades and Kallman score. Participants were classified into the HOA group and the non-HOA group. sHA levels at baseline were determined by ELISA. Correlations between sHA levels, the number of involved joints, and Kallman score were estimated. Factors related to the incidence or progression of HOA over 6 years were analyzed. The prevalence of HOA was 19.9% at baseline, and 3.6 ± 2.1 joints were involved. sHA levels in the HOA group at baseline were significantly higher than in the non-HOA group (p < 0.001) and correlated with the number of involved joints (r = 0.399, p < 0.001) and Kallman score (r = 0.540, p < 0.001). The incidence rate was 14.5%, and the progression rate was 46.1% over 6 years. Higher sHA levels at baseline were the risk factor of HOA incidence. Thus, sHA levels predicted the incidence of HOA over 6 years.
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Affiliation(s)
- Tatsuro Saruga
- Department of Orthopedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan.
| | - Eiji Sasaki
- Department of Orthopedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Ryo Inoue
- Department of Social Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Daisuke Chiba
- Department of Orthopedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Seiya Ota
- Department of Orthopedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Hiroki Iwasaki
- Department of Orthopedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Ryoko Uesato
- Department of Orthopedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Shigeyuki Nakaji
- Department of Social Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yasuyuki Ishibashi
- Department of Orthopedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
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Kondo F, Takegami Y, Ishizuka S, Hasegawa Y, Imagama S. The association of the progression of knee osteoarthritis with high-sensitivity CRP in community-dwelling people-the Yakumo study. Clin Rheumatol 2021; 40:2643-2649. [PMID: 33426633 DOI: 10.1007/s10067-020-05541-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 12/06/2020] [Accepted: 12/08/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE We aimed to investigate the relationship between high-sensitivity CRP (hs-CRP) levels and the knee osteoarthritis (KOA) status and whether high hs-CRP levels predict the progression of clinical KOA in community-dwelling people. METHODS We enrolled 247 subjects (male, n = 99; female, n = 148) who participated in the "Yakumo study" at least twice from 2003 to 2008. The KOA was evaluated by knee X-ray using the knee osteoarthritis computer-aided diagnosis (KOACAD) measurement system to obtain the mJSW, the size of the osteophyte area (OPA), and femorotibial angle (FTA). The pain intensity of the knee joint was measured using a visual analog scale (VAS, 0-100). First, we performed a multiple regression analysis to assess the relationship between the initial hs-CRP and mJSW, OPA, FTA, and VAS. Second, we examined the correlated coefficients between the amount of change hs-CRP and radiographic progressions and VAS changes. Third, we divided into two groups. Group H elevated hs-CRP levels (> 0.1 mg/dl). We picked up the subject matched to Group H according to BMI, age, sex, and medial mJSW at baseline in a 1:1 ratio; these participants were classified as the control group (Group L). The Mann-Whitney U test was used to compare the demographic data between the two groups. P values of < 0.05 were considered to indicate statistical significance. RESULTS The initial hs-CRP was a significant explanatory factor for mJSW and VAS change in multiple regression analysis. The change of VAS value negatively correlated with the change of hs-CRP. Besides, the change of hs-CRP did not correlate with the radiographical change. Among these subjects, 55 had elevated hs-CRP levels (> 0.1 mg/dl) (Group H). Among the 192 subjects whose hs-CRP levels were ≤ 0.1 mg/dl, 55 subjects were matched to patients in Group H according to the age, sex, BMI, and average minimum joint space width (mJSW) at baseline and were used as a control group (Group L). The narrowing of the medial mJSW and the amount of change in OPA in group H were significantly greater than group L. The amount of change in FTA and VAS scores did not differ between the two groups. CONCLUSION Hs-CRP levels would be significantly associated with the progression of knee osteoarthritis. Key Points • We investigated the relationship between hs-CRP levels and the progression and the pain of osteoarthritis knee. • We used a KOACAD system, which can measure the medial and lateral joint space narrowing, osteophyte, and femoral-tibia angle from plain radiographs automatically. • Hs-CRP levels were significantly associated with the progression of knee osteoarthritis.
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Affiliation(s)
- Fumiki Kondo
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550, Japan
| | - Yasuhiko Takegami
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550, Japan.
| | - Shinya Ishizuka
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550, Japan
| | - Yukiharu Hasegawa
- Department of Rehabilitation, Kansai University of Welfare Sciences, Osaka, Japan
| | - Shiro Imagama
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550, Japan
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Liem Y, Judge A, Kirwan J, Ourradi K, Li Y, Sharif M. Multivariable logistic and linear regression models for identification of clinically useful biomarkers for osteoarthritis. Sci Rep 2020; 10:11328. [PMID: 32647218 PMCID: PMC7347626 DOI: 10.1038/s41598-020-68077-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 06/16/2020] [Indexed: 12/21/2022] Open
Abstract
Osteoarthritis (OA) is the most common chronic degenerative joint disease which causes substantial joint pain, deformity and loss of activities of daily living. Currently, there are over 500 million OA cases worldwide, and there is an urgent need to identify biomarkers for early detection, and monitoring disease progression in patients without obvious radiographic damage to the joint. We have used regression modelling to describe the association of 19 of the currently available biomarkers (predictors) with key radiographic and clinical features of OA (outcomes) in one of the largest and best characterised OA cohort (NIH Osteoarthritis Initiative). We demonstrate that of the 19 currently available biomarkers only 4 (serum Coll2-1 NO2, CS846, COMP and urinary CTXII) were consistently associated with established radiographic and/or clinical features of OA. These biomarkers are independent of one another and provide additional predictive power over, and above established predictors of OA such as age, gender, BMI and race. We also show that that urinary CTXII had the strongest and consistent associations with clinical symptoms of OA as well as radiographic evidence of joint damage. Accordingly, urinary CTXII may aid in early diagnosis of OA in symptomatic patients without radiographic evidence of OA.
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Affiliation(s)
- Yulia Liem
- Translational Health Sciences, Bristol Medical School, Musculoskeletal Research Unit, Southmead Hospital, University of Bristol, Learning and Research Building (Level 2), Bristol, BS10 5NB, UK
| | - Andrew Judge
- Translational Health Sciences, Bristol Medical School, Musculoskeletal Research Unit, Southmead Hospital, University of Bristol, Learning and Research Building (Level 2), Bristol, BS10 5NB, UK
| | - John Kirwan
- University of Bristol, Biomedical Sciences Building, University Walk, Bristol, UK
| | - Khadija Ourradi
- Translational Health Sciences, Bristol Medical School, Musculoskeletal Research Unit, Southmead Hospital, University of Bristol, Learning and Research Building (Level 2), Bristol, BS10 5NB, UK
| | - Yunfei Li
- Translational Health Sciences, Bristol Medical School, Musculoskeletal Research Unit, Southmead Hospital, University of Bristol, Learning and Research Building (Level 2), Bristol, BS10 5NB, UK
| | - Mohammed Sharif
- Translational Health Sciences, Bristol Medical School, Musculoskeletal Research Unit, Southmead Hospital, University of Bristol, Learning and Research Building (Level 2), Bristol, BS10 5NB, UK.
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7
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Kozijn AE, Tartjiono MT, Ravipati S, van der Ham F, Barrett DA, Mastbergen SC, Korthagen NM, Lafeber FPJG, Zuurmond AM, Bobeldijk I, Weinans H, Stoop R. Human C-reactive protein aggravates osteoarthritis development in mice on a high-fat diet. Osteoarthritis Cartilage 2019; 27:118-128. [PMID: 30248505 DOI: 10.1016/j.joca.2018.09.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 07/17/2018] [Accepted: 09/13/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE C-reactive protein (CRP) levels can be elevated in osteoarthritis (OA) patients. In addition to indicating systemic inflammation, it is suggested that CRP itself can play a role in OA development. Obesity and metabolic syndrome are important risk factors for OA and also induce elevated CRP levels. Here we evaluated in a human CRP (hCRP)-transgenic mouse model whether CRP itself contributes to the development of 'metabolic' OA. DESIGN Metabolic OA was induced by feeding 12-week-old hCRP-transgenic males (hCRP-tg, n = 30) and wild-type littermates (n = 15) a 45 kcal% high-fat diet (HFD) for 38 weeks. Cartilage degradation, osteophytes and synovitis were graded on Safranin O-stained histological knee joint sections. Inflammatory status was assessed by plasma lipid profiling, flow cytometric analyses of blood immune cell populations and immunohistochemical staining of synovial macrophage subsets. RESULTS Male hCRP-tg mice showed aggravated OA severity and increased osteophytosis compared with their wild-type littermates. Both classical and non-classical monocytes showed increased expression of CCR2 and CD86 in hCRP-tg males. HFD-induced effects were evident for nearly all lipids measured and indicated a similar low-grade systemic inflammation for both genotypes. Synovitis scores and synovial macrophage subsets were similar in the two groups. CONCLUSIONS Human CRP expression in a background of HFD-induced metabolic dysfunction resulted in the aggravation of OA through increased cartilage degeneration and osteophytosis. Increased recruitment of classical and non-classical monocytes might be a mechanism of action through which CRP is involved in aggravating this process. These findings suggest interventions selectively directed against CRP activity could ameliorate metabolic OA development.
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Affiliation(s)
- A E Kozijn
- Metabolic Health Research, TNO, Leiden, the Netherlands; Department of Orthopaedics, University Medical Center (UMC) Utrecht, Utrecht University, Utrecht, The Netherlands; Department of Rheumatology & Clinical Immunology, UMC Utrecht, Utrecht University, Utrecht, The Netherlands
| | - M T Tartjiono
- Metabolic Health Research, TNO, Leiden, the Netherlands
| | - S Ravipati
- Centre for Analytical Bioscience, School of Pharmacy, University of Nottingham, Nottingham, United Kingdom
| | - F van der Ham
- Metabolic Health Research, TNO, Leiden, the Netherlands
| | - D A Barrett
- Centre for Analytical Bioscience, School of Pharmacy, University of Nottingham, Nottingham, United Kingdom
| | - S C Mastbergen
- Department of Rheumatology & Clinical Immunology, UMC Utrecht, Utrecht University, Utrecht, The Netherlands
| | - N M Korthagen
- Department of Orthopaedics, University Medical Center (UMC) Utrecht, Utrecht University, Utrecht, The Netherlands; Department of Equine Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - F P J G Lafeber
- Department of Rheumatology & Clinical Immunology, UMC Utrecht, Utrecht University, Utrecht, The Netherlands
| | - A M Zuurmond
- Metabolic Health Research, TNO, Leiden, the Netherlands
| | - I Bobeldijk
- Metabolic Health Research, TNO, Leiden, the Netherlands
| | - H Weinans
- Department of Orthopaedics, University Medical Center (UMC) Utrecht, Utrecht University, Utrecht, The Netherlands; Department of Rheumatology & Clinical Immunology, UMC Utrecht, Utrecht University, Utrecht, The Netherlands; Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands
| | - R Stoop
- Metabolic Health Research, TNO, Leiden, the Netherlands.
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8
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Ourradi K, Sharif M. Opportunities and challenges for the discovery and validation of proteomic biomarkers for common arthritic diseases. Biomark Med 2017; 11:877-892. [PMID: 28976778 DOI: 10.2217/bmm-2016-0374] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Osteoarthritis (OA) and rheumatoid arthritis (RA) are most prevalent among all the rheumatic diseases, and currently, there are no reliable biochemical measures for early diagnosis or for predicting who is likely to progress. Early diagnosis is important for making decisions on treatment options and for better management of patients. This narrative review highlights the first-generation biomarkers identified over the last two decades and focuses on the discovery and validation of candidate OA biomarkers from recent mass-spectrometry-based proteomic studies for diagnosis and monitoring disease outcomes in human. It discusses the challenges and opportunities for discovery of novel biomarkers and progress in the development of techniques for measuring biomarkers, and provides directions for future discovery and validation of biomarkers for OA and rheumatoid arthritis.
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Affiliation(s)
- Khadija Ourradi
- Musculoskeletal Research Unit, Translational Health Sciences Bristol Medical School, University of Bristol, Learning & Research Building, Southmead Hospital, Bristol BS10 5NB, UK
| | - Mohammed Sharif
- Musculoskeletal Research Unit, Translational Health Sciences Bristol Medical School, University of Bristol, Learning & Research Building, Southmead Hospital, Bristol BS10 5NB, UK
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9
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Goode AP, Nelson AE, Kraus VB, Renner JB, Jordan JM. Biomarkers reflect differences in osteoarthritis phenotypes of the lumbar spine: the Johnston County Osteoarthritis Project. Osteoarthritis Cartilage 2017; 25:1672-1679. [PMID: 28711584 PMCID: PMC5605465 DOI: 10.1016/j.joca.2017.07.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 06/02/2017] [Accepted: 07/05/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine differences in biomarker levels between radiographic phenotypes of facet joint osteoarthritis (FOA) only, spine OA only ((disc space narrowing (DSN) and vertebral osteophytes (OST)) or the combination of FOA and spine OA. DESIGN A cross-sectional analysis of data from 555 participants in the Johnston County Osteoarthritis Project was performed. Lumbar spine levels were graded by severity (OST and DSN) and presence (FOA) of degeneration. Biomarkers included hyaluronan (HA) and type II collagen (CTX-II). Adjusted risk ratios (aRRR) were estimated using multinomial regression, with adjustment for age, race, sex, body mass index (BMI), and radiographic OA (knee, hip, hand). Interactions were tested between sex, race and low back symptoms. RESULTS FOA only was present in 22.4%, 14.5% had spine OA only, and 34.6% had the combination of FOA and spine OA. Compared to the reference group of neither FOA or spine OA, a one unit higher ln HA level was associated with 31% higher relative risk ratio (RRR = 1.31 (95% 1.03, 1.67)) of having FOA only, while, a one unit higher lnuCTX-II level was associated with 84% higher relative risk ratio (RRR = 1.84 (95% CI 1.19, 2.84)) of having spine OA only. No significant interactions were identified. CONCLUSION Interestingly, OA affecting the synovial facet joint was associated with a marker of inflammation (HA). Spine OA, affecting intervertebral discs that contain collagen type II, was associated with a marker reflecting collagen type II degradation (CTX-II). These findings suggest that biomarkers may reflect the different pathophysiologic processes of lumbar spine OA phenotypes.
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Affiliation(s)
- Adam P. Goode
- Associate Professor, Department of Orthopedic Surgery, Duke Clinical Research Institute, Duke University School of Medicine
| | - Amanda E. Nelson
- Assistant Professor, Thurston Arthritis Research Center, University of North Carolina, Chapel Hill
| | - Virginia B. Kraus
- Professor, Duke Molecular Physiology Institute and Division of Rheumatology, Duke University School of Medicine, Durham, NC
| | - Jordan B. Renner
- Professor, Thurston Arthritis Research Center, Department of Radiology, University of North Carolina, Chapel Hill
| | - Joanne M. Jordan
- Professor, Thurston Arthritis Research Center, University of North Carolina, Chapel Hill
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Ourradi K, Xu Y, de Seny D, Kirwan J, Blom A, Sharif M. Development and validation of novel biomarker assays for osteoarthritis. PLoS One 2017; 12:e0181334. [PMID: 28715494 PMCID: PMC5513499 DOI: 10.1371/journal.pone.0181334] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 06/29/2017] [Indexed: 11/18/2022] Open
Abstract
Background Osteoarthritis (OA) is the most common chronic joint disease usually diagnosed at relatively advanced stages when there is irreparable damage to the joint(s). Recently, we have identified two novel biomarkers C3f and V65 which appear to be OA-specific and therefore potential markers of early disease. We report the development of immunoassays for quantitative measure of these two novel biomarkers. Method Monoclonal and polyclonal antibodies were generated by immunising mouse and rabbits respectively with peptide-carrier conjugates of C3f and V65. Affinity purified antibodies were used for immunoassays development and assays validated using serum from OA patients and controls. Results The ELISAs developed showed spiked recovery of up to 96% for C3f and V65 peptides depending on serum dilutions with a coefficient of variation (CV) <10%. The intra- and inter-assay CVs for C3f and V65 were 1.3–10.8% and 4.2–10.3% respectively. Both assays were insensitive for measurements of the peptides in patients and the use of different signal amplification systems did not increase assay sensitivity. Conclusion We have developed two immunoassays for measurements of C3f and V65 peptides biomarkers discovered by our earlier proteomic study. These assays could detect the endogenous peptides in serum samples from patients and controls but lacked sensitivity for accurate measurements of the peptides in patients. Our study highlights the difficulties and challenges of validating biomarker from proteomic studies and demonstrates how to overcome some of the technical challenges associated with developing immunoassays for small peptides.
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Affiliation(s)
- Khadija Ourradi
- School of Clinical Sciences, University of Bristol, Musculoskeletal Research Unit, Learning and Research Building, Southmead Hospital, Bristol, United Kingdom
| | - Yunhe Xu
- School of Clinical Sciences, University of Bristol, Musculoskeletal Research Unit, Learning and Research Building, Southmead Hospital, Bristol, United Kingdom
| | - Dominique de Seny
- Laboratory of Rheumatology, GIGA-I, University of Liege, CHU de Liege, Liege, Belgium
| | - John Kirwan
- Academic Rheumatology, University of Bristol, The Courtyard, Bristol Royal Infirmary, Bristol, United Kingdom
| | - Ashley Blom
- School of Clinical Sciences, University of Bristol, Musculoskeletal Research Unit, Learning and Research Building, Southmead Hospital, Bristol, United Kingdom
| | - Mohammed Sharif
- School of Clinical Sciences, University of Bristol, Musculoskeletal Research Unit, Learning and Research Building, Southmead Hospital, Bristol, United Kingdom
- * E-mail:
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Systemic inflammation and painful joint burden in osteoarthritis: a matter of sex? Osteoarthritis Cartilage 2017; 25:53-59. [PMID: 27546883 DOI: 10.1016/j.joca.2016.08.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 07/15/2016] [Accepted: 08/09/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE We investigated the association between serum levels of C-reactive protein (CRP) and the extent of multijoint pain among individuals with hip/knee osteoarthritis (OA) and determined whether the association differs by sex. DESIGN Serum CRP and cartilage oligomeric matrix protein (COMP) were determined by enzyme-linked immunosorbent assay (ELISA) in 189 individuals (101 female, 88 male) scheduled for total hip/knee arthroplasty for OA. Patients indicated on a homunculus all painful joints; a summed count was derived. A series of negative binomial regression models was used to investigate the cross-sectional association between painful joint count (outcome) and serum CRP concentrations, adjusting for age, sex, body mass index (BMI), comorbidity count and COMP. An interaction between sex and these biomarkers was tested. RESULTS Mean age: 66 among women, 65 among men. Women had higher mean joint count (3.7 vs 2.5, P < 0.01; 4+ joint count reported by 37% women, 25% men). Median CRP concentration was higher in women (15.4 mg/l vs 9.3, P = 0.07). From adjusted analyses, the effects of both ln(CRP) and ln(COMP) were modified by sex (P < 0.05). Increasing ln(CRP) was associated with greater painful joint count among women, but not men. CONCLUSIONS There may be a dose-response association between painful joint burden in OA and systemic inflammation, and it appears the association is sex-specific, which may in part explain inconsistent findings in the literature. Our results underline the importance of showing sex-specific associations in OA, especially when studying the influence of inflammation.
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Ruiz-Romero C, Fernández-Puente P, Blanco FJ. Biomarkers in Osteoarthritis: Value of Proteomics. BIOMARKERS IN BONE DISEASE 2017. [DOI: 10.1007/978-94-007-7693-7_44] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Duncan ST, Khazzam MS, Burnham JM, Spindler KP, Dunn WR, Wright RW. Sensitivity of standing radiographs to detect knee arthritis: a systematic review of Level I studies. Arthroscopy 2015; 31:321-8. [PMID: 25312767 DOI: 10.1016/j.arthro.2014.08.023] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 08/10/2014] [Accepted: 08/26/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to perform a systematic review of the available literature to define the level of quality evidence for determining the sensitivity and specificity of different radiographic views in detecting knee osteoarthritis and to determine the impact of different grading systems on the ability to detect knee osteoarthritis. METHODS A systematic review of the literature was conducted to identify studies that evaluated the standing anteroposterior (AP) and 45° posteroanterior (PA) views for tibiofemoral and patellofemoral arthritis and those comparing the use of the Kellgren-Lawrence versus the joint space narrowing (JSN) radiographic grading systems using arthroscopy as the gold standard. A comprehensive search of PubMed, Scopus, CINAHL, the Cochrane Database, Clinicaltrial.gov, and EMBASE was performed using the keywords "osteoarthritis," "knee," "x-ray," "sensitivity," and "arthroscopy." RESULTS Six studies were included in the evaluation. The 45° flexion PA view showed a higher sensitivity than the standing AP view for detecting severe arthritis involving either the medial or lateral tibiofemoral compartment. There was no difference in the specificities for the 2 views. The direct comparison of the Kellgren-Lawrence and the JSN radiographic grading systems found no clinical difference between the 2 systems regarding the sensitivities, although the specificity was greater for the JSN system. CONCLUSIONS The ability to detect knee osteoarthritis continues to be difficult without using advanced imaging. However, as an inexpensive screening tool, the 45° flexion PA view is more sensitive than the standing AP view to detect severe tibiofemoral osteoarthritis. When evaluating the radiograph for severe osteoarthritis using either the Kellgren-Lawrence or JSN grading system, there is no clinical difference in the sensitivity between the 2 methods; however, the JSN may be more specific for ruling in severe osteoarthritis in the medial compartment. LEVEL OF EVIDENCE Level I, systematic review of Level I studies.
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Affiliation(s)
- Stephen T Duncan
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, Kentucky, U.S.A..
| | - Michael S Khazzam
- Department of Orthopaedic Surgery, UT Southwestern Medical Center, Dallas, Texas, U.S.A
| | - Jeremy M Burnham
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, Kentucky, U.S.A
| | - Kurt P Spindler
- Department of Orthopaedic Surgery, Cleveland Clinic Sports Health Center, Cleveland, Ohio, U.S.A
| | - Warren R Dunn
- Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A
| | - Rick W Wright
- Department of Orthopaedic Surgery, Washington University School of Medicine at Barnes-Jewish Hospital, St. Louis, Missouri, U.S.A
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Haider HM, Amin IR, Ahmad KA. Plasma and synovial osteopontin levels, are they associated with disease severity of primary knee osteoarthritis in Egyptian patients? EGYPTIAN RHEUMATOLOGIST 2015. [DOI: 10.1016/j.ejr.2014.05.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Van Spil WE, Nair SC, Kinds MB, Emans PJ, Hilberdink WKHA, Welsing PMJ, Lafeber FPJG. Systemic biochemical markers of joint metabolism and inflammation in relation to radiographic parameters and pain of the knee: data from CHECK, a cohort of early-osteoarthritis subjects. Osteoarthritis Cartilage 2015; 23:48-56. [PMID: 25205017 DOI: 10.1016/j.joca.2014.09.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 08/07/2014] [Accepted: 09/01/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate associations of biochemical markers of joint metabolism and inflammation with minimum joint space width (JSW) and osteophyte area (OP area) of knees showing no or doubtful radiographic osteoarthritis (OA) and to investigate whether these differed between painful and non-painful knees. DESIGN Serum (s-) and urinary (u-) levels of the cartilage markers uCTX-II, sCOMP, sPIIANP, and sCS846, bone markers uCTX-I, uNTX-I, sPINP, and sOC, synovial markers sPIIINP and sHA, and inflammation markers hsCRP and erythrocyte sedimentation rate (ESR) were assessed in subjects from CHECK (Cohort Hip and Cohort Knee) demonstrating Kellgren and Lawrence grade ≤1 OA on knee radiographs. Minimum JSW and OP area of these knees were quantified in detail using Knee Images Digital Analysis (KIDA). RESULTS uCTX-II levels showed negative associations with minimum JSW and positive associations with OP area. sCOMP and sHA levels showed positive associations with OP area, but not with minimum JSW. uCTX-I and uNTX-I levels showed negative associations with minimum JSW and OP area. Associations of biochemical marker levels with minimum JSW were similar between painful and non-painful knees, associations of uCTX-II, sCOMP, and sHA with OP area were only observed in painful knees. CONCLUSIONS In these subjects with no or doubtful radiographic knee OA, uCTX-II might not only reflect articular cartilage degradation but also endochondral ossification in osteophytes. Furthermore, sCOMP and sHA relate to osteophytes, maybe because synovitis drives osteophyte development. High bone turnover may aggravate articular cartilage loss. Metabolic activity in osteophytes and synovial tissue, but not in articular cartilage may be related to knee pain.
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Affiliation(s)
- W E Van Spil
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, PO Box 85500, 3508 GA, Utrecht, The Netherlands.
| | - S C Nair
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, PO Box 85500, 3508 GA, Utrecht, The Netherlands.
| | - M B Kinds
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, PO Box 85500, 3508 GA, Utrecht, The Netherlands.
| | - P J Emans
- Department of Orthopaedic Surgery, Maastricht University Medical Center, PO Box 5800, 6202 AZ, Maastricht, The Netherlands.
| | - W K H A Hilberdink
- Allied Health Care Center for Rheumatology and Rehabilitation Groningen, Helpermolenstraat 25, 9721 BT, Groningen, The Netherlands.
| | - P M J Welsing
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, PO Box 85500, 3508 GA, Utrecht, The Netherlands.
| | - F P J G Lafeber
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, PO Box 85500, 3508 GA, Utrecht, The Netherlands.
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Singh S, Kumar D, Sharma NR. Role of hyaluronic Acid in early diagnosis of knee osteoarthritis. J Clin Diagn Res 2014; 8:LC04-7. [PMID: 25653977 PMCID: PMC4316283 DOI: 10.7860/jcdr/2014/11732.5342] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Accepted: 11/09/2014] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Osteoarthritis of knee is traditionally diagnosed on the basis of clinical and radiological findings. Usually joint tissue degeneration is already advanced by the time a clinical diagnosis is made, hence the research focus has now shifted to use of biomarkers to diagnose the condition at an early stage of the disease. AIMS & OBJECTIVES The aim of this study was to assess the efficacy of serum HA levels in early detection and grading of the severity of primary knee osteoarthritis and it's co-relation with Western Ontario and McMaster university osteoarthritis index (WOMAC scores) and Kellgren -Lawrence grading (K-L grade). MATERIALS AND METHODS The study included 150 subjects (100 cases and 50 controls) and all were subjected to WOMAC scoring and K-L grading and estimation of serum HA levels. RESULTS Age and WOMAC scores have significant correlation with HA levels, but multivariate analysis shows only WOMAC score as an independent variable associated with HA levels. The results show statistically significant high HA levels in cases than in normal population. HA levels are also able to differentiate between various clinical severity grades. ROC Curve analysis suggests cut-off levels of HA between mild, moderate and severe cases. CONCLUSION HA levels are able to differentiate between normal asymptomatic population and symptomatic cases and also between various severity grades of osteoarthritis.
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Affiliation(s)
- Sudhir Singh
- Professor & Head, Department of Orthopaedics, Era’s Lucknow Medical College, Lucknow, India
| | - Dharmendra Kumar
- Assistant Professor, Department of Orthopaedics, Era’s Lucknow Medical College, Lucknow, India
| | - Nishant Raj Sharma
- Junior Resident, Department of Orthopaedics, Era’s Lucknow Medical College, Lucknow, India
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Ishijima M, Kaneko H, Kaneko K. The evolving role of biomarkers for osteoarthritis. Ther Adv Musculoskelet Dis 2014; 6:144-53. [PMID: 25342994 DOI: 10.1177/1759720x14541175] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Osteoarthritis (OA) is an increasingly important public health concern as the prevalence of this disease becomes higher and higher due to the ageing population. However, in addition to the absence of disease-modifying treatments, there are no sensitive diagnostic techniques beyond classical radiography, and physicians cannot predict who will progress with the disease. As a result, disease progression cannot be prevented or halted. Therefore, there is an urgent need for more effective techniques than radiography. Reliable, quantitative and dynamic tests to detect early damage and measure the progress of treatments targeted against joint destruction are required. Biomarkers, in addition to magnetic resonance imaging, are tools that can address these therapeutic shortcomings. Structural molecules and fragments derived from bone, cartilage and the synovium, all of which are affected by OA, have been reported to be potential candidates for biomarkers of OA. As the identification of biomarkers that can be applied more broadly from the very early to the end stages of knee OA is required, advances in the OA biomarker field remain challenging, but steadily progressive. Such advances will come not only from basic, but also preclinical and clinical research. In this review, we highlight recent OA biomarker studies generally published between 2011 and 2012. We classified the studies in this review into the following three categories: unique characteristics of the urinary level of C-terminal telopeptide of type II collagen; insight into the pathophysiology of OA revealed by biochemical biomarkers; and candidates for novel biomarkers of OA revealed by proteomics.
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Affiliation(s)
- Muneaki Ishijima
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Haruka Kaneko
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kazuo Kaneko
- Department of Medicine for Orthopaedics and Motor Organ, and Sportology Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
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Aslam I, Perjar I, Shi XA, Renner JB, Kraus VB, Golightly YM, Jordan JM, Nelson AE. Associations between biomarkers of joint metabolism, hand osteoarthritis, and hand pain and function: the Johnston County Osteoarthritis Project. J Rheumatol 2014; 41:938-44. [PMID: 24584914 DOI: 10.3899/jrheum.130904] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To determine the associations between joint metabolism biomarkers and hand radiographic osteoarthritis [(rOA), based on Kellgren Lawrence (KL) grade ≥ 2], symptoms, and function. METHODS Cross-sectional data were available for 663 participants (mean age 63 yrs, 63% white, 49% women). Three definitions of hand rOA were considered: (1) a composite measure involving at least 3 hand joints distributed bilaterally with 2 of 3 in the same joint group, including ≥ 1 distal interphalangeal joint, without metacarpophalangeal (MCP) swelling; (2) rOA in at least 1 joint of a group; and (3) number of joints with KL ≥ 2. We assessed hand symptoms and the 15-item Australian Canadian Hand Osteoarthritis Index (AUSCAN; Likert format). We measured serum cartilage oligomeric matrix protein (sCOMP), hyaluronic acid (sHA), carboxy-terminal propeptide of type II collagen, type II collagen degradation product, urinary C-terminal crosslinked telopeptide of type II collagen, and urinary N-terminal crosslinked telopeptide. Linear regression models were performed to assess associations between each biomarker with hand rOA, AUSCAN, and symptoms, adjusting for age, sex, race, current smoking/drinking status, body mass index, and hip and knee rOA. RESULTS In adjusted analyses, MCP (p < 0.0001) and carpometacarpal rOA (p = 0.003), and a higher number of hand joints with rOA (p = 0.009), were associated with higher levels of sHA. Positive associations were seen between AUSCAN and hand symptoms and levels of sCOMP (p ≤ 0.003) and sHA (p ≤ 0.048). CONCLUSION Hand symptoms and higher AUSCAN scores were independently associated with higher levels of both sCOMP and sHA; hand rOA was associated only with sHA levels.
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Affiliation(s)
- Imran Aslam
- From the Northeast Ohio Medical School, Rootstown, Ohio; the School of Medicine, the Thurston Arthritis Research Center, the Department of Radiology, the Department of Epidemiology, and the Department of Orthopedics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill; SAS Institute, Cary; Duke University School of Medicine, Durham, NC, USA
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Jin X, Beguerie JR, Zhang W, Blizzard L, Otahal P, Jones G, Ding C. Circulating C reactive protein in osteoarthritis: a systematic review and meta-analysis. Ann Rheum Dis 2013; 74:703-10. [DOI: 10.1136/annrheumdis-2013-204494] [Citation(s) in RCA: 147] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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20
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Yusuf E, Kloppenburg M. Epidemiological studies on adipokines and osteoarthritis. ACTA ACUST UNITED AC 2013. [DOI: 10.2217/ijr.13.18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Rousseau JC, Garnero P. Biological markers in osteoarthritis. Bone 2012; 51:265-77. [PMID: 22538364 DOI: 10.1016/j.bone.2012.04.001] [Citation(s) in RCA: 102] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2011] [Revised: 03/07/2012] [Accepted: 04/03/2012] [Indexed: 12/01/2022]
Abstract
Osteoarthritis (OA) is considered as a chronic disease with a long "silent" period. The diagnosis is generally based on clinical symptoms and radiographic changes. However X-ray has a poor sensitivity and a relatively large precision error that does not allow an early detection of OA or the monitoring of joint damage progression. The limitations of the tools that are currently available for OA assessment have been the impetus to identify specific biological markers that reflect quantitative and dynamic variations in joint remodeling. Research has focused on the structural components of cartilage matrix, especially type II collagen degradation markers. In spite of a significant increase of some markers in individuals with early stage of OA, the large overlap with control subjects indicates that the current biomarkers used alone have limited diagnostic potential. However, the combination of specific markers seems to improve the prediction of disease progression at the individual level. Several types of treatment have been investigated but the lack of medications with definitively demonstrated chondroprotective activity has limited the assessment of the potential role of biomarkers for monitoring patients' responses to the treatment of OA. In this review, we will use the BIPED classification that appeared in 2006 for OA markers to describe the potential usage of a given marker [5]. This article is part of a Special Issue entitled "Osteoarthritis".
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Affiliation(s)
- J Ch Rousseau
- INSERM Unit 1033; Pathophysiology, Diagnosis and Treatments of bone diseases, Université de Lyon, Lyon, France.
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Darwish AF, Abdel-Ghany HS, El-Sherbini YM. Diagnostic and prognostic value of some biochemical markers in early knee osteoarthritis. EGYPTIAN RHEUMATOLOGIST 2012. [DOI: 10.1016/j.ejr.2011.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Huang W, Sowa G. Biomarker development for musculoskeletal diseases. PM R 2011; 3:S39-44. [PMID: 21703579 DOI: 10.1016/j.pmrj.2011.04.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Accepted: 04/28/2011] [Indexed: 12/31/2022]
Abstract
More than one in 4 Americans has a musculoskeletal (MSK) disorder that requires medical diagnosis and treatment. Imaging tools are able to demonstrate structural changes but cannot reflect the disease activity or symptom severity of MSK conditions. This is of paramount concern in the aging population, in which imaging findings have poor correlation with symptoms, and multiple pain generators frequently coexist. Because levels of inflammatory and matrix breakdown products address disease activity, evaluation of biomarkers has the potential to provide assessment of active pain generators above and beyond the changes observable on imaging studies. This fact has stimulated research interest in the search for novel biomarkers of disease activity and response to treatment in body fluids. The goal is to develop panels of multi-biomarkers, which could be used independently or in conjunction with the imaging tools, for the diagnosis, prognosis, and treatment validation in MSK diseases. The current review of MSK biomarkers is organized into 3 mechanistic categories: the metabolites of extracellular matrix of MSK tissues; inflammatory cytokines and chemokines; and pain-related neuropeptides and/or chemicals. Although some representative biomarkers could be used alone, the fact that MSK diseases are multi-tissue disorders that involve the muscles, bones, cartilage, and nerves suggests that panels of biomarkers may have greater potential than any single biomarker used in isolation. As advances in biotechnology make this a reality, multi-biomarker panels that include all 3 categories of biomarkers, used either alone or in combination with imaging tools, has the potential to revolutionize the clinical approach to MSK diseases.
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Affiliation(s)
- Wan Huang
- Department of Physical Medicine and Rehabilitation, Ferguson Laboratory for Orthopaedic Research, University of Pittsburgh, Pittsburgh, PA, USA
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Vlad SC, Neogi T, Aliabadi P, Fontes JDT, Felson DT. No association between markers of inflammation and osteoarthritis of the hands and knees. J Rheumatol 2011; 38:1665-70. [PMID: 21572158 DOI: 10.3899/jrheum.100971] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Local inflammation plays a prominent role in osteoarthritis (OA). This could be reflected in the presence of elevated soluble inflammatory markers. We conducted analyses to assess the association of inflammatory markers with radiographic OA of the hands and knees in a large community-based cohort. METHODS The Framingham Offspring cohort consists of the adult children of the original cohort and their spouses. In 1998-2001 these subjects provided blood specimens that were tested for 17 markers of systemic inflammation. In 2002-2005 these subjects had radiographs of both knees and hands. Each hand and knee joint was assigned a Kellgren and Lawrence (KL) score (0-4). We used logistic regression with generalized estimating equations and adjustment for age, sex, and body mass index to examine the association between each inflammatory marker and the presence of radiographic OA (ROA = KL grade ≥ 2) in any joint. We also constructed models for hand joints and knee joints alone. RESULTS Radiographs and measures of inflammation were done for 1235 subjects (56% women, mean age 65 yrs). Of that group, 729 subjects (59%) had ROA in ≥ 1 hand or knee joint: 179 (14.3%) had knee OA, and 694 (56.2%) had hand OA. There were no significant associations between any marker of inflammation and ROA. CONCLUSION In this large sample, in which OA was carefully assessed and multiple markers measured, we found no evidence of an association between any inflammatory marker and the presence of radiographic OA.
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Affiliation(s)
- Steven C Vlad
- Clinical Epidemiology Research and Training Unit and the Division of Rheumatology, Boston University School of Medicine, Boston, MA 02118, USA.
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De Ceuninck F, Sabatini M, Pastoureau P. Recent progress toward biomarker identification in osteoarthritis. Drug Discov Today 2011; 16:443-9. [DOI: 10.1016/j.drudis.2011.01.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2010] [Accepted: 01/14/2011] [Indexed: 11/30/2022]
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The serum levels of Receptor Activator of Nuclear Factor-κB Ligand, bone-specific alkaline phosphatase, osteocalcin and osteoprotegerin do not correlate with the radiographically assessed severity of idiopathic hip and knee osteoarthritis. Clin Biochem 2011; 44:203-7. [DOI: 10.1016/j.clinbiochem.2010.09.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2010] [Revised: 09/24/2010] [Accepted: 09/29/2010] [Indexed: 11/23/2022]
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Biochemical markers in the diagnosis of chondral defects following anterior cruciate ligament insufficiency. INTERNATIONAL ORTHOPAEDICS 2011; 35:1633-7. [PMID: 21221577 DOI: 10.1007/s00264-010-1191-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2010] [Accepted: 12/10/2010] [Indexed: 10/18/2022]
Abstract
PURPOSE The aim of this study was to determine the value of systemic biochemical markers of bone turnover-urine levels of cross-linked C-terminal telopeptide I (uCTX-I), urinary C-terminal telopeptide II (uCTX-II) and serum cartilage oligomeric matrix protein (sCOMP)-in the diagnosis of chondral defects after anterior cruciate ligament (ACL) rupture. Thirty-eight patients with previous ACL rupture were included. METHODS Magnetic resonance imaging (MRI) of the injured and the intact knee joint was performed with volumetric measurement of volume and area of cartilage (VC/AC), area of subchondral bone (cAB), and area of subchondral bone denuded and eroded (dAB). Biochemical markers were measured using commercially available enzyme-linked immunoassays. RESULTS MRI-based volumetric cartilage measurement showed significant differences between the injured and the intact knees. uCTX-I, sCOMP and in parts uCTX-II correlated well with MRI parameters. CTX-I showed a significant correlation with VC and AC of the whole knee joint. CONCLUSIONS The results suggest that uCTX-I, uCTX-II and sCOMP could identify patients with focal cartilage lesions from an early stage of osteoarthritis of the knee.
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Abstract
Analysis of Serum Proteins and Enzymes Level in Human Subjects with OsteoarthritisThe aim of the present study was to assess the serum proteins and enzymes level using polyacrylamide gel electrophoretic (PAGE) profiles in human subjects with osteoarthritis (OA). Forty-one subjects with confirmed OA were selected for the present study. Sera were collected from these individuals and loaded in equal amounts on native and denaturing PAGE separately. Software analysis of these profiles was done using Scion Imaging (Beta release-4, Scion Corporation) and GelPro (Media Cybernetics, USA) programs. To visualize esterases (Est) and lactate dehydrogenase (LDH) isoenzymes in the sera of these patients substrate specific staining was performed. Differences in the values of control and OA subjects were tested statistically. Software analysis of native-PAGE profiles revealed the presence of nineteen peptides in control and twenty one in OA subjects respectively. Two extra peptides were present in the β-globulins region of OA subjects. Significant decline from 42.77% to 34.72% in albumin levels (hypoalbuminemia) was observed in OA subjects with total albumin to globulin ratio 0.58. In SDS-PAGE, the difference in control and OA subjects was observed among eight peptides with molecular weight 25, 22 and 20 kDa (absent in OA) and five novel peptides 270, 125, 30, 21.36 and 18.4 kDa (absent in controls), while albumin retains the major activity. For enzymes, Est follow a relative order, BchEst (42.86%)> ArylEst (16.24%)>AchEst (6.85%) in OA subjects with the expression of a new BchEst isoform in 4.78% and two isoforms of ArylEst at 2.13 and 1.61% concentrations respectively. Significantly declined albumin esterase-like activity (AlbEst) was observed (34%) (P<0.05) in diseased subjects compared with controls (47%). Significant increase in LDH-5 and decline in LDH-1 and -2 isoenzymes were also observed in the sera of OA subjects. However, the overall rank of LDH isoenzymes was similar in control and OA subjects. Our results demonstrate noticeable differences in the sera PAGE profiles and enzymes activity in control and OA subjects and provide evidence to select serum for its use in the search for suitable biochemical markers in osteoarthritis.
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Significance of the serum CTX-II level in an osteoarthritis animal model: a 5-month longitudinal study. Osteoarthritis Cartilage 2010; 18:1467-76. [PMID: 21056352 DOI: 10.1016/j.joca.2010.07.007] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2009] [Revised: 07/05/2010] [Accepted: 07/16/2010] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The aim of this study was to investigate the clinical value of serum measurement of C-telopeptide of type II collagen (CTX-II). In correlation with late stages of osteoarthritis (OA) evaluated with histological assessment, the evolution of serum CTX-II concentration was followed during a 20-week longitudinal study in rabbit anterior cruciate ligament transection (ACLT) OA model in adult and growing animals. METHODS OA was induced in five adult and nine growing rabbits. Four adult and four young rabbits were unoperated. Serum sampling was made at week 0, 1, 2, 3, 4, 6, 8, 10, 12, 14, 16 and 20 after the surgery in all rabbits. Animals were euthanized 20 weeks after the surgery. Serum CTX-II levels were analyzed with a recently available enzyme-linked immunosorbent assay (ELISA) kit, the protocol of which has been modified to increase the sensitivity of the test. RESULTS Significant differences for the CTX-II levels at W3, W6, W8, W10, W12, W14, W16 and W20 were observed between the adult ACLT and the control groups. A negative correlation between CTX-II levels and cartilage thickness of the medial compartment of the knee at W8, W10, W12 and a positive correlation between the CTX-II levels and the histomorphological score of the medial compartment of the knee at W3, W6, W8, W10, W12 were noted in adult animals. In young animals, operated or not, we observed high CTX-II levels at the beginning of the study, which decreased until the end. CONCLUSION Our results suggest the interest of the serum CTX-II monitoring for the OA progression and the relevance of the multiple time point analysis of this biomarker. Moreover, they address the question of the importance of correctly choosing the age of the animals used in the pre-clinical studies of OA.
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Kwan Tat S, Lajeunesse D, Pelletier JP, Martel-Pelletier J. Targeting subchondral bone for treating osteoarthritis: what is the evidence? Best Pract Res Clin Rheumatol 2010; 24:51-70. [PMID: 20129200 DOI: 10.1016/j.berh.2009.08.004] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Over the past few decades, significant progress has been made with respect to new concepts about the pathogenesis of osteoarthritis (OA). This article summarises some of the knowledge we have today on the involvement of the subchondral bone in OA. It provides substantial evidence that changes in the metabolism of the subchondral bone are an integral part of the OA disease process and that these alterations are not merely secondary manifestations, but are part of a more active component of the disease. Thus, a strong rationale exists for therapeutic approaches that target subchondral bone resorption and/or formation, and data evaluating the drugs targeting bone remodelling raise the hope that new treatment options for OA may become available.
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Affiliation(s)
- Steeve Kwan Tat
- Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), Notre-Dame Hospital, 1560 Sherbrooke Street East, Montreal, Quebec H2L 4M1, Canada
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BERRY PATRICIAA, MACIEWICZ ROSEA, CICUTTINI FLAVIAM, JONES MARKD, HELLAWELL CAROLINEJ, WLUKA ANITAE. Markers of Bone Formation and Resorption Identify Subgroups of Patients with Clinical Knee Osteoarthritis Who Have Reduced Rates of Cartilage Loss. J Rheumatol 2010; 37:1252-9. [DOI: 10.3899/jrheum.091055] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective.To determine whether serum markers of bone formation and resorption, used individually or in combination, can be used to identify subgroups who lose cartilage volume at different rates over 2 years within a knee osteoarthritis (OA) population.Methods.Changes in cartilage volume over 2 years were measured in 117 subjects with knee OA using magnetic resonance imaging. We examined relationships between change in cartilage volume and baseline serum markers of bone formation [intact N-terminal propeptide of type I procollagen (PINP) and osteocalcin] and resorption [N-telopeptide of type I collagen (NTX-I), C-telopeptide of type I collagen (CTX-I), and C-telopeptide of type I collagen (ICTP).Results.The baseline markers of bone formation, PINP and osteocalcin (p = 0.02, p = 0.01, respectively), and the baseline markers of bone resorption, CTX-I and NTX-I (p = 0.02 for both), were significantly associated with reduced cartilage loss. There were no significant associations between baseline ratios of bone formation to resorption markers and cartilage loss. However, when subjects were divided into subgroups with high or low bone formation markers (based on levels of marker ≥ mean or < mean for the population, respectively), in the subgroup with high PINP there was a significant association between increasing bone resorption markers CTX-I and NTX-I and reduced cartilage loss (p = 0.02, p = 0.001, respectively). Similarly, in the subgroup with high osteocalcin, there was a significant association between increasing CTX-I and NTX-I and reduced cartilage loss (p = 0.02, p = 0.003, respectively). In contrast, in subgroups with low bone formation markers, no significant associations were obtained between markers of bone resorption and cartilage loss.Conclusion.Overall, the results suggest that higher bone remodeling (i.e., higher serum levels of bone formation and resorption) is associated with reduced cartilage loss. Considering markers of bone formation and resorption together, it is possible to identify subgroups within the OA population who have reduced rates of cartilage loss.
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Kraus VB, Kepler TB, Stabler T, Renner J, Jordan J. First qualification study of serum biomarkers as indicators of total body burden of osteoarthritis. PLoS One 2010; 5:e9739. [PMID: 20305824 PMCID: PMC2840035 DOI: 10.1371/journal.pone.0009739] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2009] [Accepted: 02/03/2010] [Indexed: 12/01/2022] Open
Abstract
Background Osteoarthritis (OA) is a debilitating chronic multijoint disease of global proportions. OA presence and severity is usually documented by x-ray imaging but whole body imaging is impractical due to radiation exposure, time and cost. Systemic (serum or urine) biomarkers offer a potential alternative method of quantifying total body burden of disease but no OA-related biomarker has ever been stringently qualified to determine the feasibility of this approach. The goal of this study was to evaluate the ability of three OA-related biomarkers to predict various forms or subspecies of OA and total body burden of disease. Methodology/Principal Findings Female participants (461) with clinical hand OA underwent radiography of hands, hips, knees and lumbar spine; x-rays were comprehensively scored for OA features of osteophyte and joint space narrowing. Three OA-related biomarkers, serum hyaluronan (sHA), cartilage oligomeric matrix protein (sCOMP), and urinary C-telopeptide of type II collagen (uCTX2), were measured by ELISA. sHA, sCOMP and uCTX2 correlated positively with total osteophyte burden in models accounting for demographics (age, weight, height): R2 = 0.60, R2 = 0.47, R2 = 0.51 (all p<10−6); sCOMP correlated negatively with total joint space narrowing burden: R2 = 0.69 (p<10−6). Biomarkers and demographics predicted 35–38% of variance in total burden of OA (total joint space narrowing or osteophyte). Joint size did not determine the contribution to the systemic biomarker concentration. Biomarker correlation with disease in the lumbar spine resembled that in the rest of the skeleton. Conclusions/Significance We have suspected that the correlation of systemic biomarkers with disease has been hampered by the inability to fully phenotype the burden of OA in a patient. These results confirm the hypothesis, revealed upon adequate patient phenotyping, that systemic joint tissue concentrations of several biomarkers can be quantitative indicators of specific subspecies of OA and of total body burden of disease.
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Affiliation(s)
- Virginia B Kraus
- Department of Medicine, Duke University Medical Center, Durham, North Carolina, United States of America.
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Abstract
Arthrosis deformans is a common disease worldwide with a high prevalence among all ethnic groups. All joints may be affected and genetic factors influence the onset of the disease. The main symptoms include pain and increasing immobility over the course of the illness. Treatment in early stages is conservative. In the final stages of disease the implantation of an endoprosthesis, as well as bracing depending on the joint in question, are possible. Complete healing of the disease is not possible to date; however, medicamentous or genetic-therapy approaches are currently the subject of intensive research.
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Affiliation(s)
- S Rehart
- Klinik für Orthopädie und Unfallchirurgie, Markus-Krankenhaus, Akademisches Lehrkrankenhaus der Johann Wolfgang Goethe-Universität, Wilhelm-Epstein-Strasse 2, 60431 Frankfurt a. M., Deutschland.
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