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Biological markers in osteoarthritis

Abstract

Osteoarthritis (OA) is a progressive disorder characterized by destruction of articular cartilage and subchondral bone, and by synovial changes. The diagnosis of OA is generally based on clinical and radiographic changes, which occur fairly late during disease progression and have poor sensitivity for monitoring disease progression. Progression of joint damage is likely to result primarily from an imbalance between cartilage degradation and repair, so measuring markers of these processes would seem a promising approach to improve the prediction of disease progression at the individual level. Moreover, genetic markers might be useful predictors of prognosis. The lack of fully effective, chondroprotective medications has limited the use of such potential markers to monitor the effect of treatment for OA. Nevertheless, owing to their dynamic changes in response to treatment, biological markers might provide relevant information more rapidly than imaging techniques (such as radiography and MRI) can, and should contribute to our understanding of mechanisms that underlie the clinical efficacy of OA treatments. Most of the identified genes involved in OA encode signal-transduction proteins, which provide the potential for novel therapeutic approaches. In this Review, we will use the recently proposed BIPED (i.e. burden of disease, investigative, prognostic, efficacy of intervention and diagnostic) classification of OA markers to describe the potential usage of a given marker.

Key Points

  • Although levels of some biomarkers of joint metabolism might be significantly increased in groups of patients with early stages of osteoarthritis (OA), these markers cannot be used as diagnostic tests for OA in individual patients

  • 'Burden of disease' markers can only be used for clinical studies, because the individual values obtained in groups of patients with different degrees of OA burden overlap

  • The combined use of several markers seems to be necessary to improve the prediction of disease progression at the individual level; genetic markers might contribute to the prognostic assessment of patients with OA

  • Owing to their rapid changes in response to therapy, biological markers might provide relevant information more rapidly than imaging techniques (radiography and MRI) can, and should contribute to our understanding of mechanisms underlying the clinical efficacy of treatments for OA

  • Validation of genetic approaches is awaited, but in the meantime they provide new information on the pathogenesis of OA and might lead to the identification of new markers with potential clinical utility

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Figure 1: Schematic localization of epitopes in type II procollagen
Figure 2: Association of urinary levels of CTX-II with radiologically visible degeneration of lumbar spine disks, radiologically detectable knee OA, and clinically evident hand OA in untreated, postmenopausal women

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Acknowledgements

Désirée Lie, University of California, CA, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the Medscape-accredited continuing medical education activity associated with this article.

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Correspondence to Jean-Charles Rousseau.

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Rousseau, JC., Delmas, P. Biological markers in osteoarthritis. Nat Rev Rheumatol 3, 346–356 (2007). https://doi.org/10.1038/ncprheum0508

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