Cited by 476Osteoarthritis Treatment and MechanismsRheumatoid Arthritis Research and TherapiesProteoglycans and glycosaminoglycans research

Cross sectional evaluation of biochemical markers of bone, cartilage, and synovial tissue metabolism in patients with knee osteoarthritis: relations with disease activity and joint damage

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Garnero, P, Piperno, M, Gineyts, E, Christgau, S, Delmas, P D, Vignon, E·2001·Annals of the Rheumatic Diseases

Abstract

Objective To analyse the relations between the urinary levels of type II collagen C-telopeptide (CTX-II) and glucosyl-galactosyl pyridinoline (Glc-Gal-PYD)-two newly developed biochemical markers of type II collagen and synovial tissue destruction respectively-disease activity and the severity of joint destruction in patients with knee osteoarthritis (OA). The clinical performance of these two new markers was compared with that of a panel of other established biochemical markers of connective tissue metabolism. Methods The following biochemical markers were measured in a group of 67 patients with knee OA (mean age 64 years, median disease duration eight years ) and in 67 healthy controls: for bone, serum osteocalcin, serum and urinary C-telopeptide of type I collagen (CTX-I); for cartilage, urinary CTX-II, serum cartilage oligomeric matrix protein (COMP), and serum human cartilage glycoprotein 39 (YKL-40); for synovium, urinary Glc-Gal-PYD, serum type III collagen N-propeptide (PIIINP), serum hyaluronic acid (HA); and for inflammation, serum C reactive protein. Biochemical markers were correlated with pain and physical function (WOMAC index) and with quantitative radiographic evaluation of the joint space using the posteroanterior view of the knees flexed at 30 degrees. Results All bone turnover markers were decreased in patients with knee OA compared with controls (-36%, -38%, and -52%, p<0.0001 for serum osteocalcin, serum CTX-I and urinary CTX-I, respectively). Serum COMP (+16%, p=0.0004), urinary CTX-II (+25%, p=0.0009), urinary Glc-Gal-PYD (+18%, p=0.028), serum PIIINP (+33%, p<0.0001), and serum HA (+ 233%, p<0.0001) were increased. By univariate analyses, increased urinary Glc-Gal-PYD (r=0.41, p=0.002) and decreased serum osteocalcin (r=-0.30, p=0.025) were associated with a higher total WOMAC index. Increased urinary CTX-II (r=-0.40, p=0.0002) and Glc-Gal-PYD (r=-0.30, p=0.0046) and serum PIIINP (r=-0.29, p=0.0034) were the only markers which correlated with joint surface area. By multivariate analyses, urinary Glc-Gal-PYD and CTX-II were the most important predictors of the WOMAC index and joint damage, respectively. Conclusion Knee OA appears to be characterised by a systemic decrease of bone turnover and increased cartilage and synovial tissue turnover. CTX-II, Glc-Gal-PYD, and PIIINP may be useful markers of disease severity in patients with knee OA.

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  • Inter-laboratory standardization and age/sex/ethnicity-stratified reference ranges remain challenges for broad adoption of CTX-II and COMP.

    “Though inter-laboratory standardization and age/sex/ethnicity-stratified reference ranges remain challenges for broad adoption”

    From Biomarker-Guided Imaging and AI-Augmented Diagnosis of Degenerative Joint Disease (2025) · cites this paper as [28]

    The Markers of cartilage turnover section reports CTX-II and COMP assay methods and intra- and interassay variability, but not inter-laboratory standardization. The Healthy subjects section describes age- and sex-characterized controls; neither it nor the Discussion addresses ethnicity-stratified reference ranges or identifies these issues as barriers to broad adoption (pages unavailable in our copy). (LLM, conf=0.72)

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Research works printed but not linked: 7

  1. Garnero P, Rousseau J-C, Delmas P. Molecular basis and clinical use of biochemical markers of bone, cartilage and synovium in joint diseases. Arthritis Rheum 2000;43:953- 61.
  2. Lohmander LS, Ionescu M, Jugessur H, Poole AR. Changes in joint cartilage aggrecan after knee injury and osteoarthri- tis. Arthritis Rheum 1999;42:534-44.
  3. Hilal G, Martel-Pelletier J, Pelletier J-P, Ranger P, Lajeunesse D. Osteoblast-like cells from human subchon- dral bone demonstrate an altered phenotype in vitro. Arthritis Rheum 1998;41:891-9.
  4. Arden NK, Nevitt MC, Lane NE, Gore R, Hochberg MC, Scott JC, et al. Osteoarthritis and the risk of falls, rates of bone loss and osteoporotic fractures. Arthritis Rheum 1999;42:1378-85.
  5. Sowers M, Lachance L, Jadamar D, Hochberg MC, Hollis B, Crutchfield M, et al. The associations of bone mineral density and bone turnover with osteoarthritis of the hand and knee in pre and perimenopausal women. Arthritis Rheum 1999;42:483-9.
  6. Hellio le Graverand MP, Tron AM, Ichoa M, Dalland MC, Richard M, Uebelhart D, et al. Assessment of urinary hydroxypyridinium crosslink measurements in osteoarthri- tis. BMJ 1996;35:1091-5.
  7. Clark AG, Jordan JM, Vilim V, Renner JB, Dragomir AD, Luta G, et al. Serum cartilage oligomeric matrix protein reflects osteoarthritis presence and severity. Arthritis Rheum 1999;42:2356-64.

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Authors
Garnero, P., Piperno, M., Gineyts, E., Christgau, S., Delmas, P. D., & Vignon, E.
Affiliations
Inserm (FR)
Corresponding author
Garnero, P
Venue
Annals of the Rheumatic Diseases
Publisher
Elsevier BV
Published
2001-06
Volume
60
Issue
6
Pages
619-626
ISSN
0003-4967 (ISSN-L)
OpenAlex
W2125310185
Cited by
475
References
62
Citations by year
2026: 2 · 2025: 8 · 2024: 11 · 2023: 10 · 2022: 7 · 2021: 13 · 2020: 18 · 2019: 16 · 2018: 17 · 2017: 13 · 2016: 13 · 2015: 20 · 2014: 21 · 2013: 14 · 2012: 18
FWCI
29.55
Type
journal article
Language
en
Open access
Locations
  • Annals of the Rheumatic Diseases (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed (publishedVersion)
Funders
Institut National de la Santé et de la Recherche Médicale
Topics
  • Health Sciences › Medicine › Rheumatology › Osteoarthritis Treatment and Mechanisms
  • Health Sciences › Medicine › Rheumatology › Rheumatoid Arthritis Research and Therapies
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Cell Biology › Proteoglycans and glycosaminoglycans research
Keywords
knee osteoarthritis, biochemical markers, type II collagen, C-terminal telopeptide, cartilage metabolism, bone turnover markers, osteocalcin, cartilage oligomeric matrix protein, YKL-40, hyaluronic acid, disease activity, joint destruction
MeSH terms
Aged, Aged, 80 and over, Amino Acids, Bone and Bones, Cartilage, Articular, Collagen, Cross-Sectional Studies, Female, Galactosides, Humans, Knee Joint, Male, Middle Aged, Peptide Fragments, Peptides, Procollagen, Radiography, Severity of Illness Index, Synovial Membrane, Biomarkers, Body Mass Index, Multivariate Analysis, Osteoarthritis, Knee, Collagen Type I, Collagen Type II

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