Dündar Ümit, Aşık Gülşah, Ulaşlı Alper Murat, Sınıcı Şükrü, Yaman Fatima, Solak Özlem, Toktaş Hasan, Eroğlu Selma
Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Afyon Kocatepe University, Afyonkarahisar, Turkey.
Department of Microbiology, Faculty of Medicine, Afyon Kocatepe University, Afyonkarahisar, Turkey.
Int J Rheum Dis. 2016 Mar;19(3):287-93. doi: 10.1111/1756-185X.12565. Epub 2015 May 8.
The use of biomarkers of osteoarthritis (OA) have potential for early diagnosis, evaluation of disease severity and monitoring treatment. Serum and synovial fluid YKL-40 levels are increased in severe knee OA. Pulsed electromagnetic field (PEMF) therapy is a novel treatment method for OA. However, studies evaluating the PEMF therapy in treatment of knee OA revealed conflicting results. This study was conducted to objectively assess the effect of PEMF therapy in patients with knee OA, by using ultrasonographic measurements and a novel biomarker, YKL-40.
Forty patients were randomized into two treatment groups. Both groups received conventional physical therapy, while Group 1 received additional PEMF therapy. The patients were asked to rate their pain on a visual analogue scale (VAS) and complete a Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire. Serum YKL-40 levels were measured, and knee effusion and cartilage degeneration level were evaluated with ultrasonography before and after treatment.
Pre-treatment YKL-40 level was correlated with WOMAC pain subscale (P = 0.032, r = 0.339). VAS and WOMAC scores significantly improved in both treatment groups (P < 0.05). The effusion in the right knee significantly decreased in Group 1. The change in YKL-40 level was not correlated with the change in VAS, WOMAC scores and knee effusion.
This study revealed that adjuvant PEMF therapy has no additional effect on pain in patients with knee OA. Serum YKL-40 level seems to be unuseful for monitoring the treatment in knee OA.
骨关节炎（OA）生物标志物的应用在早期诊断、疾病严重程度评估及治疗监测方面具有潜力。严重膝关节OA患者的血清和滑液中YKL-40水平升高。脉冲电磁场（PEMF）疗法是一种治疗OA的新方法。然而，评估PEMF疗法治疗膝关节OA的研究结果相互矛盾。本研究旨在通过超声测量和一种新型生物标志物YKL-40，客观评估PEMF疗法对膝关节OA患者的疗效。
40例患者随机分为两个治疗组。两组均接受常规物理治疗，而第1组额外接受PEMF治疗。要求患者用视觉模拟评分法（VAS）对疼痛进行评分，并完成西安大略和麦克马斯特大学骨关节炎指数（WOMAC）问卷。测量血清YKL-40水平，并在治疗前后用超声评估膝关节积液和软骨退变程度。
治疗前YKL-40水平与WOMAC疼痛子量表相关（P = 0.032，r = 0.339）。两个治疗组的VAS和WOMAC评分均显著改善（P < 0.05）。第1组右膝关节积液明显减少。YKL-40水平的变化与VAS、WOMAC评分及膝关节积液的变化无关。
本研究表明，辅助PEMF疗法对膝关节OA患者的疼痛无额外影响。血清YKL-40水平似乎对监测膝关节OA的治疗无效。
