RHEUMATOLOGY
Rheumatology 2014;53:21912195 doi:10.1093/rheumatology/keu253 Advance Access publication 23 June 2014
Concise report Bone and cartilage metabolism markers in synovial fluid of the hip joint with secondary osteoarthritis Ryosuke Yamaguchi1, Takuaki Yamamoto1, Goro Motomura1, Satoshi Ikemura1, Kenyu Iwasaki1, Garida Zhao1, Toshio Doi1 and Yukihide Iwamoto1
Methods. We studied 70 synovial fluid samples obtained from 57 patients with ONFH (mean age 46 years, 34 males, 23 females), 21 samples obtained from 21 patients with RDA (mean age 70 years, 2 males, 19 females) and 20 samples obtained from 20 patients with DDH (mean age 56 years, 2 males, 18 females). The levels of bone alkaline phosphatase (BAP) and tartrate-resistant acid phosphatase 5b (TRACP-5b), as bone metabolism markers, and matrix metalloproteinase 3 (MMP-3) and keratan sulphate (KS), as cartilage metabolism markers, were analysed. Results. The levels of BAP, MMP-3 and KS were significantly higher in the ONFH group than in the RDA and DDH groups. The levels of TRACP-5b were highest in the RDA group. The levels of BAP in the ONFH group after the development of osteoarthritic changes were significantly lower than those observed in earlier stages. In comparisons between the samples obtained from each group with a terminal condition, the ONFH samples exhibited significantly higher MMP-3 and KS levels, while the TRACP-5 levels were highest in the RDA group. Conclusion. The ONFH patients showed a relatively bone formative condition before the osteoarthritic stage and maintained a higher rate of cartilage turnover throughout several stages compared with the RDA and DDH patients. RDA patients were characterized by a significantly high osteoclast activity. Key words: hip osteoarthritis, osteonecrosis of the femoral head, rapidly destructive arthrosis, developmental dysplasia of the hip, synovial fluid analysis, bone metabolism marker, cartilage metabolism marker.
Introduction OA of the hip joint occurs secondary to several underlying hip diseases, including osteonecrosis of the femoral head (ONFH), rapidly destructive arthrosis of the hip (RDA) and developmental dysplasia of the hip (DDH). Although the terminal condition is dysfunction of the hip joint, eventually requiring surgical treatment, the underlying diseases demonstrate respectively unique radiological findings and remarkably different clinical time courses. ONFH is 1 Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Submitted 28 January 2014; revised version accepted 25 April 2014. Correspondence to: Takuaki Yamamoto, Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan. E-mail: [email protected]
radiologically characterized by femoral head collapse that is often progressive and causes eventual joint space narrowing over a period of several months to years [1, 2]. RDA involves rapid destruction of the femoral head and acetabulum accompanied by progressive joint space narrowing within a short term of several weeks to months [3]. DDH is characterized by insufficient acetabular covering of the femoral head, which occasionally progresses to osteoarthritic changes over several decades [4]. Although the major treatment option for these underlying diseases is hip joint replacement [5], other treatment options, such as osteotomy or preservative treatment, are also adopted in some patients, particularly those in the early stage of disease [6]. Understanding the clinical time course characteristics of these conditions enables physicians to select more suitable treatment options.
! The Author 2014. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: [email protected]
CLINICAL SCIENCE
Objective. The aim of this study was to compare the levels of bone and cartilage metabolism markers in the synovial fluid of the hip joint between patients with secondary OA due to osteonecrosis of the femoral head (ONFH), rapidly destructive arthrosis (RDA) and developmental dysplasia of the hip (DDH).
Downloaded from http://rheumatology.oxfordjournals.org/ at University of California, San Francisco on December 9, 2014
Abstract
Ryosuke Yamaguchi et al.
Several studies have emphasized that biomarkers in the synovial fluid potentially reflect the direct condition of the affected joint [79]. Markers of cartilage metabolism are useful for estimating the severity of joint diseases, and markers of bone metabolism are also important, notably in individuals with joint diseases involving bone destruction, such as ONFH and RDA. However, no previous reports have simultaneously analysed these markers in patients with secondary hip OA. The purpose of this study was thus to compare the levels of bone and cartilage metabolism markers in the synovial fluid of the hip joint among patients with ONFH, RDA and DDH.
This study was approved by the Kyushu University Institutional Review Board for Clinical Research. We studied 70 synovial fluid samples obtained from 57 patients with ONFH, 21 samples obtained from 21 patients with RDA and 20 samples obtained from 20 patients with DDH treated at our institution between 2009 and 2011. All synovial fluid samples were obtained at the time of surgery and stored frozen at 80 C until analysis. The ONFH patients consisted of 34 males and 23 females, with ages ranging from 20 to 75 years (mean age 46 years). Twenty-seven patients had a history of corticosteroid administration, another 27 patients had a history of alcohol abuse and the other 3 patients had both histories. Patients with traumatic ONFH were excluded from this study. ONFH was classified into three groups according to the classification of the Japanese Investigation Committee of the Ministry of Health, Labour and Welfare [10]. A total of 33 hips were classified as having stage 3A disease, defined as collapse of the femoral head of
Rheumatology 2014;53:21912195 doi:10.1093/rheumatology/keu253 Advance Access publication 23 June 2014
Concise report Bone and cartilage metabolism markers in synovial fluid of the hip joint with secondary osteoarthritis Ryosuke Yamaguchi1, Takuaki Yamamoto1, Goro Motomura1, Satoshi Ikemura1, Kenyu Iwasaki1, Garida Zhao1, Toshio Doi1 and Yukihide Iwamoto1
Methods. We studied 70 synovial fluid samples obtained from 57 patients with ONFH (mean age 46 years, 34 males, 23 females), 21 samples obtained from 21 patients with RDA (mean age 70 years, 2 males, 19 females) and 20 samples obtained from 20 patients with DDH (mean age 56 years, 2 males, 18 females). The levels of bone alkaline phosphatase (BAP) and tartrate-resistant acid phosphatase 5b (TRACP-5b), as bone metabolism markers, and matrix metalloproteinase 3 (MMP-3) and keratan sulphate (KS), as cartilage metabolism markers, were analysed. Results. The levels of BAP, MMP-3 and KS were significantly higher in the ONFH group than in the RDA and DDH groups. The levels of TRACP-5b were highest in the RDA group. The levels of BAP in the ONFH group after the development of osteoarthritic changes were significantly lower than those observed in earlier stages. In comparisons between the samples obtained from each group with a terminal condition, the ONFH samples exhibited significantly higher MMP-3 and KS levels, while the TRACP-5 levels were highest in the RDA group. Conclusion. The ONFH patients showed a relatively bone formative condition before the osteoarthritic stage and maintained a higher rate of cartilage turnover throughout several stages compared with the RDA and DDH patients. RDA patients were characterized by a significantly high osteoclast activity. Key words: hip osteoarthritis, osteonecrosis of the femoral head, rapidly destructive arthrosis, developmental dysplasia of the hip, synovial fluid analysis, bone metabolism marker, cartilage metabolism marker.
Introduction OA of the hip joint occurs secondary to several underlying hip diseases, including osteonecrosis of the femoral head (ONFH), rapidly destructive arthrosis of the hip (RDA) and developmental dysplasia of the hip (DDH). Although the terminal condition is dysfunction of the hip joint, eventually requiring surgical treatment, the underlying diseases demonstrate respectively unique radiological findings and remarkably different clinical time courses. ONFH is 1 Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Submitted 28 January 2014; revised version accepted 25 April 2014. Correspondence to: Takuaki Yamamoto, Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan. E-mail: [email protected]
radiologically characterized by femoral head collapse that is often progressive and causes eventual joint space narrowing over a period of several months to years [1, 2]. RDA involves rapid destruction of the femoral head and acetabulum accompanied by progressive joint space narrowing within a short term of several weeks to months [3]. DDH is characterized by insufficient acetabular covering of the femoral head, which occasionally progresses to osteoarthritic changes over several decades [4]. Although the major treatment option for these underlying diseases is hip joint replacement [5], other treatment options, such as osteotomy or preservative treatment, are also adopted in some patients, particularly those in the early stage of disease [6]. Understanding the clinical time course characteristics of these conditions enables physicians to select more suitable treatment options.
! The Author 2014. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: [email protected]
CLINICAL SCIENCE
Objective. The aim of this study was to compare the levels of bone and cartilage metabolism markers in the synovial fluid of the hip joint between patients with secondary OA due to osteonecrosis of the femoral head (ONFH), rapidly destructive arthrosis (RDA) and developmental dysplasia of the hip (DDH).
Downloaded from http://rheumatology.oxfordjournals.org/ at University of California, San Francisco on December 9, 2014
Abstract
Ryosuke Yamaguchi et al.
Several studies have emphasized that biomarkers in the synovial fluid potentially reflect the direct condition of the affected joint [79]. Markers of cartilage metabolism are useful for estimating the severity of joint diseases, and markers of bone metabolism are also important, notably in individuals with joint diseases involving bone destruction, such as ONFH and RDA. However, no previous reports have simultaneously analysed these markers in patients with secondary hip OA. The purpose of this study was thus to compare the levels of bone and cartilage metabolism markers in the synovial fluid of the hip joint among patients with ONFH, RDA and DDH.
This study was approved by the Kyushu University Institutional Review Board for Clinical Research. We studied 70 synovial fluid samples obtained from 57 patients with ONFH, 21 samples obtained from 21 patients with RDA and 20 samples obtained from 20 patients with DDH treated at our institution between 2009 and 2011. All synovial fluid samples were obtained at the time of surgery and stored frozen at 80 C until analysis. The ONFH patients consisted of 34 males and 23 females, with ages ranging from 20 to 75 years (mean age 46 years). Twenty-seven patients had a history of corticosteroid administration, another 27 patients had a history of alcohol abuse and the other 3 patients had both histories. Patients with traumatic ONFH were excluded from this study. ONFH was classified into three groups according to the classification of the Japanese Investigation Committee of the Ministry of Health, Labour and Welfare [10]. A total of 33 hips were classified as having stage 3A disease, defined as collapse of the femoral head of
