The utility of synovial fluid levels of ADAMTS9 and ADAMTS4 in predicting treatment responses to intraarticular steroid injections in patients with knee osteoarthritis

Abstract

Background/aim This study aims to identify the role of synovial fluid levels of a disintegrin and metalloproteinase with thrombospondin motifs 9 (ADAMTS9) and a disintegrin and metalloproteinase with thrombospondin motifs 4 (ADAMTS4) for the prediction of intraarticular steroid injection success in knee osteoarthritis (OA). Material and methods A total of eighty-four advanced stage knee OA patients (42 with stage 3 OA and 42 with stage 4 OA) were enrolled in the study. Baseline and posttreatment outcomes were determined using Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Pretreatment synovial fluid ADAMTS9 and ADAMTS4 levels were measured by enzyme linked immunosorbent assay (ELISA). ‘’Total WOMAC score regression of 18% and above’’ was taken as a minimal clinically important difference (MCID) to indicate improvement. Determining the best predictors of intraarticular steroid injection success in both groups was evaluated by multiple logistic regression analyses. Results Synovial fluid ADAMTS9 levels were significantly lower in the stage 4 OA group when compared with the stage 3 group. The level of synovial fluid ADAMTS9 was statistically significantly lower in the WOMAC score percent change ≥18% than the WOMAC score percent change <18% group in Stage 3 OA group (P = 0.026). Decreasing synovial fluid ADAMTS9 levels (odds ratio (OR): 0.625, 95% confidence interval (CI): 0.437–0.893) were found to be predictive for the WOMAC score percent change ≥18 in all OA patients (P = 0.010). Decreasing ADAMTS9 levels in synovial fluid (OR: 0.602; 95% CI = 0.372–0.974) were predictive for MCID in stage 3 OA patients ( P = 0.039). Conclusion The lower levels of ADAMTS9 in synovial fluid may be used in conjunction with high WOMAC scores in the prediction of intraarticular steroid injection success and advanced stage knee OA patients.

ADAMTS‐4 as a possible distinguishing indicator between osteoarthritis and haemophilic arthropathy

“…They concluded that ADAMTS‐4 in mild OA patients was significantly higher than in other advanced OA groups and healthy controls 22 . Significance of synovial fluid ADAMTS‐4 and ‐9 levels in OA progression were evaluated, and no significant differences were found in ADAMTS‐4 synovial fluid levels of stage 3 and 4 OA patients 23 . The pathogenesis of articular cartilage damage in the two aforementioned conditions may have a different pattern that entails a different expression profile of molecules that are activated and lead to damage.…”

“…22 Significance of synovial fluid ADAMTS-4 and -9 levels in OA progression were evaluated, and no significant differences were found in ADAMTS-4 synovial fluid levels of stage 3 and 4 OA patients. 23 The pathogenesis of articular cartilage damage in the two aforementioned conditions may have a different pattern that entails a different expression profile of molecules that are activated and lead to damage. As previously mentioned, the study by Li et al found elevated serum levels of ADAMTS-4 in mild OA forms, 22 which is in contrast to our findings, which show larger individual levels in severe OA compared to mild disease forms; the largest increase was observed in the group of patients with HA, which was not thus far explored by other authors.…”

Psoriasis ve Psoriatik Artrit Hastalarında ADAMTS9 ve ADAMTS15 mRNA Ekspresyon Düzeylerinin Araştırılması

“…Daha önceki bir çalışmada osteoartrit (OA) hastalarının kıkırdak dokusunda ADAMTS9 ve ADAMTS15 genlerinin ekspresyon düzeylerinin normal kıkırdak dokusuna göre önemli derecede azaldığı rapor edilmiştir (22). Başka bir çalışmada, OA' li hastaların sinovial sıvısında ADAMTS9 düzeylerinin azaldığı ve intraartiküler tedaviye yanıtın izlenmesinde ADAMTS9 düzeylerininin belirteç olabileceği ifade edilmiştir (23). Kronik inflamatuar romatoik bir hastalık olan Spondiliarthritis (SpA) de, hastaların dentritik hücrelerinde ADAMTS15 gen ekspresyonunun artış gösterdiği ve bu artışın doku inflamasyonu ve hasarı ile ilişkili olabileceği bildirilmiştir (24).…”