{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T11:27:31Z","timestamp":1790940451819,"version":"4.1.0"},"reference-count":47,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2002,10,16]],"date-time":"2002-10-16T00:00:00Z","timestamp":1034726400000},"content-version":"vor","delay-in-days":15,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Arthritis &amp; Rheumatism"],"published-print":{"date-parts":[[2002,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>The hallmark of osteoarthritis (OA) is the loss of articular cartilage. This loss arises from an imbalance between cartilage synthesis and cartilage degradation over a variable period of time. The aims of this study were to investigate the rates of these processes in patients with knee OA using two new molecular markers and to investigate whether the combined use of these markers could predict the progression of joint damage evaluated by both radiography and arthroscopy of the joints during a period of 1 year.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Seventy\u2010five patients with medial knee OA (51 women, 24 men; mean \u00b1 SD age 63 \u00b1 8 years, mean \u00b1 SD disease duration 4.8 \u00b1 5.2 years) were studied prospectively. At baseline, we measured serum levels of N\u2010propeptide of type IIA procollagen (PIIANP) and urinary excretion of C\u2010terminal crosslinking telopeptide of type II collagen (CTX\u2010II) as markers of type II collagen synthesis and degradation, respectively. Joint space width (JSW) on radiography and medial chondropathy at arthroscopy (assessed using a 100\u2010mm visual analog scale [VAS]) were measured in all patients at baseline and in 52 patients at 1 year. Progression of joint destruction was defined as a decrease of \u22650.5 mm in JSW on radiography and as increased chondropathy (an increase in the VAS score of &gt;8.0 units) between the baseline and 1\u2010year evaluations.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>At baseline, compared with 58 healthy age\u2010 and sex\u2010matched controls, patients with knee OA had decreased serum levels of PIIANP (20 ng\/ml versus 29 ng\/ml; <jats:italic>P<\/jats:italic> &lt; 0.001) and increased urinary excretion of CTX\u2010II (618 ng\/mmole creatinine [Cr] versus 367 ng\/mmole Cr; <jats:italic>P<\/jats:italic> &lt; 0.001). The highest discrimination between OA patients and controls was obtained by combining PIIANP and CTX\u2010II in an uncoupling index (Z score CTX\u2010II \u2212 Z score PIIANP), which yielded a mean Z score of 2.9 (<jats:italic>P<\/jats:italic> &lt; 0.0001). Increased baseline values in the uncoupling index were associated with greater progression of joint damage evaluated either by changes in JSW (r = \u22120.46, <jats:italic>P<\/jats:italic> = 0.0016) or by VAS score (r = 0.36, <jats:italic>P<\/jats:italic> = 0.014). Patients with both low levels of PIIANP (less than or equal to the mean \u2212 1 SD in controls) and high levels of CTX\u2010II (greater than or equal to the mean + 1 SD in controls) had an 8\u2010fold more rapid progression of joint damage than other patients (<jats:italic>P<\/jats:italic> = 0.012 and <jats:italic>P<\/jats:italic> &lt; 0.0001 as assessed by radiography and arthroscopy, respectively) and had relative risks of progression of 2.9 (95% confidence interval [95% CI] 0.80\u201311.1) and 9.3 (95% CI 2.2\u201339) by radiography and arthroscopy, respectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Patients with knee OA are characterized by an uncoupling of type II collagen synthesis and degradation which can be detected by assays for serum PIIANP and urinary CTX\u2010II. The combination of these two new markers could be useful for identifying knee OA patients at high risk for rapid progression of joint damage.<\/jats:p><\/jats:sec>","DOI":"10.1002\/art.10576","type":"journal-article","created":{"date-parts":[[2002,10,17]],"date-time":"2002-10-17T19:54:35Z","timestamp":1034884475000},"page":"2613-2624","source":"Crossref","is-referenced-by-count":245,"title":["Uncoupling of type II collagen synthesis and degradation predicts progression of joint damage in patients with knee 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