Abstract
BackgroundEarly diagnosis of knee osteoarthritis (OA) remains a diagnostic challenge. Urinary C-terminal cross-linked telopeptide of type II collagen (urinary CTX-II) is one of the potential OA biomarkers. However, conclusive evidence regarding the use of this biomarker as a tool for early diagnosis is still lacking. The purposes of this study were to compare urinary CTX-II levels in patients with knee OA and in healthy controls, to evaluate the correlation between urinary CTX-II levels, radiographic severity of OA, and patient-reported outcomes and to evaluate the effect of age and gender on urinary CTX-II levels in the Asian populations.MethodsTwo groups were studied. The OA group included 78 patients with knee OA aged > 40 years who met the diagnostic criteria for knee OA described by the American College of Rheumatology (ACR). The control group consisted of 51 healthy participants age > 40 years without clinical or radiographic evidence of knee OA. Bilateral knee radiographs were taken and classified according to the Kellgren and Lawrence (KL) grading system. Urinary CTX-II was measured using a competitive ELISA test and Western Ontario and Mcmaster Universities Arthritis Index (WOMAC) was also recorded in all participants.ResultsUrinary CTX-II was significantly higher in the OA group than in the control group (p < 0.001). The severe knee OA group (KL grade 3 and 4) had higher urinary CTX-II levels than mild knee OA group (KL grade 2) but the difference did not reach statistical significance (p = 0.2). There was a moderate correlation between urinary CTX-II levels and KL grades (r = 0.405, p < 0.001) and a weak correlation between urinary CTX-II levels and WOMAC index scores (r = 0.367, p < 0.001). Multiple regression analysis showed that urinary CTX-II was independently associated with KL grades. Whereas age, gender, and WOMAC index had no statistically significant influence on the urinary CTX-II levels.ConclusionsPatients with knee OA had higher urinary CTX-II levels than healthy controls. Moreover, levels of urinary CTX-II were independently correlated with radiographic severity of knee OA. Age, gender, and patient-reported outcomes exerted no effect on the urinary CTX-II levels.Level of evidenceDiagnostic Level III.
Highlights
Diagnosis of knee osteoarthritis (OA) remains a diagnostic challenge
The control group consisted of 51 healthy participants aged > 40 years without clinical or radiographic evidence of knee OA as indicated by a Kellgren and Lawrence (KL) grade 0 or 1 [19]
We found that the urinary Cterminal cross-linked telopeptide of type II collagen (CTX-II) levels in patients with knee OA were higher than that in healthy controls (p < 0.001)
Summary
Diagnosis of knee osteoarthritis (OA) remains a diagnostic challenge. Conclusive evidence regarding the use of this biomarker as a tool for early diagnosis is still lacking. Osteoarthritis (OA) represents the most common chronic joint disease that contributes to joint pain and disability. OA has a negative impact on the physical and mental health of patients who suffer from the condition. More than half of patients suffering from knee OA are under the age of 65 years. Diagnosis of knee OA remains a diagnostic challenge due to the limited signs and symptoms presented during the early phase of the disease. Radiographic evidence of OA is a potential late sign that irreversible joint damage may have already occurred [4]. Magnetic resonance imaging (MRI) and biomarkers are potential diagnostic tools used to overcome this problem. The use of MRI is limited by cost, availability, and the absence of a validated international scoring system [5]
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