Department of Rheumatology, Al-Azhar University 4, Shohada St, Mohandesin, Cairo, Egypt.
Mod Rheumatol. 2011 Oct;21(5):500-8. doi: 10.1007/s10165-011-0441-8. Epub 2011 Mar 27.
The aim of this study was to examine the relationship among three different parameters used to assess cartilage in osteoarthritis (OA) of the knee. These parameters are phonoarthrography (Phono-A), musculoskeletal ultrasonography (MSUS) from the 4 condyles, and biochemical markers; notably, matrix metalloproteinase-3 (MMP-3) and tissue inhibitor of proteinase (TIMP-1). A total of 100 knees with chronic idiopathic OA diagnosed according to the American College of Rheumatology (ACR) criteria were studied, together with 50 normal knees. The knee sounds were recorded by Phono-A and the cartilage thickness was measured by MSUS. All patients and controls had MMP-3 and TIMP-1 measured in a blood sample, using an enzyme-linked immunosorbent assay (ELISA). Conventional knee X-rays were obtained for diagnosis and for Kellgren-Lawrence (K-L) grading purposes. The results showed that Phono-A values were inversely correlated with cartilage thickness, both of these being sensitive parameters for cartilage degeneration. Phono-A values were higher in patients than in controls, denoting more degeneration of cartilage, and the cartilage thickness of all 4 condyles showed significant reductions in patients compared with normal controls. Most of the patients were categorized as grade 2 (36%) and grade 3 (30%) of the K-L classification. Mean levels of MMP-3 and TIMP-1 were significantly elevated in both groups but they were not correlated with each other. MMP-3 continued to rise with increasing radiological grades until grade 4, where it fell unexpectedly. In conclusion, Phono-A and cartilage thickness measured by MSUS seem to support each other. They can be used as parameters for following up cartilage in OA of the knees. The first deals with the roughness of the cartilage surface and the second with its thickness, complementing each other. MMP-3 continues to rise in early and middle grades of OA, denoting cartilage destruction.
本研究旨在探讨三种不同参数在膝关节骨关节炎（OA）评估中的关系。这些参数包括关节音描记术（Phono-A）、膝关节 4 个髁骨的肌肉骨骼超声（MSUS）和生化标志物；特别是基质金属蛋白酶-3（MMP-3）和组织抑制剂金属蛋白酶-1（TIMP-1）。共研究了 100 例经美国风湿病学会（ACR）标准诊断的慢性特发性 OA 膝关节，以及 50 例正常膝关节。通过 Phono-A 记录膝关节声音，并通过 MSUS 测量软骨厚度。所有患者和对照者均通过酶联免疫吸附试验（ELISA）测量血样中的 MMP-3 和 TIMP-1。获得常规膝关节 X 射线用于诊断和 Kellgren-Lawrence（K-L）分级目的。结果表明，Phono-A 值与软骨厚度呈负相关，两者均为软骨退变的敏感参数。患者的 Phono-A 值高于对照组，表明软骨退变更严重，与正常对照组相比，所有 4 个髁骨的软骨厚度均显著减少。大多数患者分为 K-L 分类的 2 级（36%）和 3 级（30%）。两组的 MMP-3 和 TIMP-1 平均水平均显著升高，但彼此不相关。MMP-3 随着放射学分级的增加而持续升高，直到 4 级，然后出乎意料地下降。总之，Phono-A 和 MSUS 测量的软骨厚度似乎相互支持。它们可作为膝关节 OA 中软骨随访的参数。前者与软骨表面粗糙度有关，后者与软骨厚度有关，相互补充。MMP-3 在 OA 的早期和中期持续升高，表明软骨破坏。
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