Synovial Fluid Biomarkers in Knee Osteoarthritis: A Systematic Review and Quantitative Evaluation Using BIPEDs Criteria
Open accessAbstract
Objective: The aim of this systematic review was to analyze the evidence about the efficacy of the several synovial fluid (SF) biomarkers proposed for knee osteoarthritis (OA), categorizing them by both molecular characteristics and clinical use according to the BIPEDs criteria, to provide a comprehensive and structured overview of the current literature. Design: A systematic review was performed in May 2020 on PubMed, Cochrane Library, and Embase databases about SF biomarkers in patients with knee OA. The search was limited to articles in the last 20 years on human studies, involving patients with knee OA, reporting SF biomarkers. The evidence for each selected SF biomarker was quantified according to the 6 categories of BIPEDs classification. Results: A total of 159 articles were included in the qualitative data synthesis and 201 different SF biomarkers were identified. Among these, several were investigated multiple times in different articles, for a total of 373 analyses. The studies included 13,557 patients with knee OA. The most promising SF biomarkers were C4S, IL-6, IL-8, Leptin, MMP-1/3, TIMP-1, TNF-α, and VEGF. The “burden of disease” and “diagnostic” categories were the most represented with 132 and 106 different biomarkers, respectively. Conclusions: The systematic review identified numerous SF biomarkers. However, despite the high number of studies on the plethora of identified molecules, the evidence about the efficacy of each biomarker is supported by limited and often conflicting findings. Further research efforts are needed to improve the understanding of SF biomarkers for a better management of patients with knee OA.
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Mass spectrometry provides greater accuracy for cytokine measurement but requires sophisticated procedures.
“Although it requires sophisticated procedures, mass spectrometry provides greater accuracy [53].”
From Biomarker-Guided Imaging and AI-Augmented Diagnosis of Degenerative Joint Disease (2025) · cites this paper as [53]
The Results discuss cytokines as synovial-fluid biomarkers, and the Discussion calls for improved biomarker assays, but neither passage assesses mass spectrometry. Searches for mass spectrometry, measurement accuracy, and procedural complexity found no passage supporting the claimed trade-off. (LLM, conf=0.76)
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- Authors
- Boffa, A., Merli, G., Andriolo, L., Lattermann, C., Salzmann, G. M., & Filardo, G.
- Affiliations
- Istituto Ortopedico Rizzoli (IT)
- Brigham and Women's Hospital (US)
- Schulthess-Klinik (CH)
- Corresponding author
- Merli, Giulia
- ORCID
- Venue
- CARTILAGE
- Publisher
- SAGE Publications
- Published
- 2020-07-25
- Volume
- 13
- Issue
- 1_suppl
- Pages
- 82S-103S
- ISSN
- 1947-6035 (ISSN-L)
- 1947-6043
- PMC
- PMC8808867
- OpenAlex
- W3043970368
- Cited by
- 99
- References
- 184
- Citations by year
- 2026: 26 · 2025: 22 · 2024: 18 · 2023: 19 · 2022: 9 · 2021: 4 · 2020: 1
- FWCI
- 1.28
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Cartilage (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- 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, synovial fluid biomarkers, interleukin-6, interleukin-8, leptin, matrix metalloproteinases, TIMP-1, TNF-α, vascular endothelial growth factor, disease burden, diagnosis
- MeSH terms
- Humans, Inflammation, Knee Injuries, Synovial Fluid, Biomarkers, Cytokines, Osteoarthritis, Knee
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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