Inflammatory Biomarker Monitoring in the Management of Osteoarthritis Among Elderly Patients with Joint Disease
DOI:
https://doi.org/10.5281/zenodo.22814063Keywords:
osteoarthritis, inflammatory biomarkers, elderly, cytokines, disease monitoringAbstract
Background: Osteoarthritis (OA) is increasingly understood as driven by low-grade synovial and systemic inflammation, not mechanical wear alone, renewing interest in inflammatory biomarkers for monitoring disease activity in elderly joint disease.
Objective: This review synthesizes evidence on inflammatory and joint-tissue-turnover biomarkers relevant to OA monitoring in older adults, their correlation with imaging, and confounding by aging-related inflammation and comorbidity.
Methods: We reviewed cohort studies, biomarker qualification consortia, and systematic reviews addressing C-reactive protein and interleukin-6, cartilage-degradation markers including cartilage oligomeric matrix protein and matrix metalloproteinases, and multi-marker panels in knee and hip OA.
Findings: C-reactive protein and interleukin-6 associate with radiographic presence, progression, and pain trajectory; cartilage-degradation markers track severity and treatment response; multi-marker panels outperform single analytes, though inflammaging, sarcopenia, and comorbidity confound single-marker interpretation in elderly patients.
Conclusions: No single biomarker meets the bar for stand-alone monitoring in elderly osteoarthritis; its most defensible role is within a multi-marker strategy combined with imaging and clinical assessment, pending validation studies designed for older, multimorbid patients.
References
Hunter, D.J., Bierma-Zeinstra, S. (2019) Osteoarthritis. Lancet, 393(10182): 1745-1759.
Berenbaum, F. (2013) Osteoarthritis as an inflammatory disease (osteoarthritis is not osteoarthrosis!). Osteoarthritis and Cartilage, 21(1): 16-21.
Franceschi, C., Garagnani, P., Parini, P., Giuliani, C., Santoro, A. (2018) Inflammaging: a new immune-metabolic viewpoint for age-related diseases. Nature Reviews Endocrinology, 14(10): 576-590.
Ferrucci, L., Fabbri, E. (2018) Inflammageing: chronic inflammation in ageing, cardiovascular disease, and frailty. Nature Reviews Cardiology, 15(9): 505-522.
Jordan, J.M., Helmick, C.G., Renner, J.B., Luta, G., Dragomir, A.D., Woodard, J., et al. (2003) Prevalence of knee symptoms and radiographic and symptomatic knee osteoarthritis in African Americans and Caucasians: the Johnston County Osteoarthritis Project. Journal of Rheumatology, 34(1): 172-180.
Felson, D.T. (2013) Osteoarthritis as a disease of mechanics. Osteoarthritis and Cartilage, 21(1): 10-15.
Loeser, R.F., Goldring, S.R., Scanzello, C.R., Goldring, M.B. (2012) Osteoarthritis: a disease of the joint as an organ. Arthritis and Rheumatism, 64(6): 1697-1707.
Robinson, W.H., Lepus, C.M., Wang, Q., Raghu, H., Mao, R., Lindstrom, T.M., et al. (2016) Low-grade inflammation as a key mediator of the pathogenesis of osteoarthritis. Nature Reviews Rheumatology, 12(10): 580-592.
Fernandes, J.C., Martel-Pelletier, J., Pelletier, J.P. (2002) The role of cytokines in osteoarthritis pathophysiology. Biorheology, 39(1-2): 237-246.
Scanzello, C.R., Goldring, S.R. (2012) The role of synovitis in osteoarthritis pathogenesis. Bone, 51(2): 249-257.
Spector, T.D., Hart, D.J., Nandra, D., Doyle, D.V., Mackillop, N., Gallimore, J.R., et al. (1997) Low-level increases in serum C-reactive protein are present in early osteoarthritis of the knee and predict progressive disease. Arthritis and Rheumatism, 40(4): 723-727.
Sturmer, T., Brenner, H., Koenig, W., Gunther, K.P. (2004) Severity and extent of osteoarthritis and low grade systemic inflammation as assessed by high sensitivity C reactive protein. Annals of the Rheumatic Diseases, 63(2): 200-205.
Livshits, G., Zhai, G., Hart, D.J., Kato, B.S., Wang, H., Williams, F.M., et al. (2009) Interleukin-6 is a significant predictor of radiographic knee osteoarthritis: the Chingford study. Arthritis and Rheumatism, 60(7): 2037-2045.
Stannus, O., Jones, G., Cicuttini, F., Parameswaran, V., Quinn, S., Burgess, J., et al. (2010) Circulating levels of IL-6 and TNF-alpha are associated with knee radiographic osteoarthritis and knee cartilage loss in older adults. Osteoarthritis and Cartilage, 18(11): 1441-1447.
Stannus, O.P., Jones, G., Blizzard, L., Cicuttini, F.M., Ding, C. (2013) Associations between serum levels of inflammatory markers and change in knee pain over 5 years in older adults: a prospective cohort study. Annals of the Rheumatic Diseases, 72(4): 535-540.
Penninx, B.W., Abbas, H., Ambrosius, W., Nicklas, B.J., Davis, C., Messier, S.P., et al. (2004) Inflammatory markers and physical function among older adults with knee osteoarthritis. Journal of Rheumatology, 31(10): 2027-2031.
Attur, M., Krasnokutsky, S., Statnikov, A., Samuels, J., Li, Z., Friedman, A.L., et al. (2015) Low-grade inflammation in symptomatic knee osteoarthritis: prognostic value of inflammatory plasma lipids and peripheral blood leukocyte biomarkers. Arthritis and Rheumatology, 67(11): 2905-2915.
Clark, A.G., Jordan, J.M., Vilim, V., Renner, J.B., Dragomir, A.D., Luta, G., et al. (1999) Serum cartilage oligomeric matrix protein reflects osteoarthritis presence and severity: the Johnston County Osteoarthritis Project. Arthritis and Rheumatism, 42(11): 2356-2364.
Sharif, M., Saxne, T., Shepstone, L., Kirwan, J.R., Elson, C.J., Heinegard, D., et al. (1995) Relationship between serum cartilage oligomeric matrix protein levels and disease progression in osteoarthritis of the knee joint. British Journal of Rheumatology, 34(4): 306-310.
Bay-Jensen, A.C., Hoegh-Madsen, S., Dam, E., Henriksen, K., Sondergaard, B.C., Pastoureau, P., et al. (2010) Which elements are involved in reversible and irreversible cartilage degradation in osteoarthritis? Rheumatology International, 30(4): 435-442.
Pelletier, J.P., Raynauld, J.P., Caron, J., Mineau, F., Abram, F., Dorais, M., et al. (2010) Decrease in serum level of matrix metalloproteinases is predictive of the disease-modifying effect of osteoarthritis drugs assessed by quantitative MRI in patients with knee osteoarthritis. Annals of the Rheumatic Diseases, 69(12): 2095-2101.
Karsdal, M.A., Bay-Jensen, A.C., Lories, R.J., Abramson, S., Spector, T., Pastoureau, P., et al. (2016) The coupling of bone and cartilage turnover in osteoarthritis: opportunities for bone antiresorptives and anabolics as potential treatments. Annals of the Rheumatic Diseases, 73(2): 336-348.
Kraus, V.B., Kepler, T.B., Stabler, T., Renner, J., Jordan, J. (2010) First qualification study of serum biomarkers as indicators of total body burden of osteoarthritis. PLoS One, 5(3): e9739.
Roemer, F.W., Guermazi, A., Felson, D.T., Niu, J., Nevitt, M.C., Crema, M.D., et al. (2011) Presence of MRI-detected joint effusion and synovitis increases the risk of cartilage loss in knees without osteoarthritis at 30-month follow-up: the MOST study. Annals of the Rheumatic Diseases, 70(10): 1804-1809.
Hunter, D.J., Guermazi, A., Roemer, F., Zhang, Y., Neogi, T. (2011) Structural correlates of pain in joints with osteoarthritis. Osteoarthritis and Cartilage, 19(10): 1170-1177.
van Spil, W.E., DeGroot, J., Lems, W.F., Oostveen, J.C., Lafeber, F.P. (2010) Serum and urinary biochemical markers for knee and hip-osteoarthritis: a systematic review applying the consensus BIPED criteria. Osteoarthritis and Cartilage, 18(5): 605-612.
Kraus, V.B., Collins, J.E., Hargrove, D., Losina, E., Nevitt, M., Katz, J.N., et al. (2017) Predictive validity of biochemical biomarkers in knee osteoarthritis: data from the FNIH OA Biomarkers Consortium. Annals of the Rheumatic Diseases, 76(1): 186-195.
Misra, D., Fielding, R.A., Felson, D.T., Niu, J., Brown, C., Nevitt, M., et al. (2015) Risk of knee osteoarthritis with obesity, sarcopenic obesity, and sarcopenia. Arthritis and Rheumatology, 71(2): 232-237.
Losina, E., Paltiel, A.D., Weinstein, A.M., Yelin, E., Hunter, D.J., Chen, S.P., et al. (2015) Lifetime medical costs of knee osteoarthritis management in the United States: impact of extending indications for total knee arthroplasty. Arthritis Care and Research, 67(2): 203-215.
Bruyere, O., Cooper, C., Pelletier, J.P., Branco, J., Brandi, M.L., Guillemin, F., et al. (2016) An algorithm recommendation for the management of knee osteoarthritis in Europe and internationally: a report from a task force of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO). Seminars in Arthritis and Rheumatism, 45(4 Suppl): S3-S11.
Vlad, S.C., Neogi, T., Aliabadi, P., Fontes, J.D., Felson, D.T. (2011) No difference in comparative effectiveness of glucosamine and chondroitin versus placebo for knee osteoarthritis after adjustment for trial quality. Osteoarthritis and Cartilage, 19(11): 1204-1206.
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