Serum hs-CRP Levels Do Not Correlate With Carotid Intima-Media Thickness in Knee Osteoarthritis
AbstractKnee osteoarthritis (KOA) is prevalent morbidity which is associated with increased cardiovascular (CV) mortality. Any means to add to the risk stratification strategies especially prior to the total arthroplasty operations is of great applicability in terms of patient safety and cost reduction. We investigated the correlation between serum high sensitivity C-reactive protein (hs-CRP) levels, as a measure of CV risk, and common carotid intima-media thickness (IMT), as the cursor of underlying atherosclerosis. In a cross-sectional study, serum hs-CRP levels and common carotid IMT were determined in 68 patients with KOA. The mean serum hs-CRP level was 1.85±1.98 mg/L, and the mean carotid IMT was 0.67±0.16 centimeters with a Pearson’s R=0.016 (P=0.898). Using linear regression models, no correlation was found between hs-CRP and IMT. Findings indicate the poor ability of hs-CRP to predict underlying atherosclerosis in patients with KOA. Although hs-CRP has been shown to be a powerful prognostic tool in general and is associated with increased mortality in patients with KOA, its applicability to predict the atherosclerosis risk especially prior to operation is limited. Further investigation to find the best cost-effective non-invasive indicator of CV risk in patients with KOA is mandatory.
Yoshimura N, Muraki S, Oka H, Kawaguchi H, Nakamura K, Akune T. Association of knee osteoarthritis with the accumulation of metabolic risk factors such as overweight, hypertension, dyslipidemia, and impaired glucose tolerance in Japanese men and women: the ROAD study. The Journal of rheumatology. 2011;38:921-30.
Nüesch E, Dieppe P, Reichenbach S, Williams S, Iff S, Jüni P. All cause and disease specific mortality in patients with knee or hip osteoarthritis: population based cohort study. Bmj. 2011;342:d1165.
Hawker GA, Croxford R, Bierman AS, Harvey PJ, Ravi B, Stanaitis I, Lipscombe LL. All-cause mortality and serious cardiovascular events in people with hip and knee osteoarthritis: a population based cohort study. PloS one. 2014;9:e91286.
Hoeven TA, Kavousi M, Clockaerts S, Kerkhof HJ, van Meurs JB, Franco O, Hofman A, Bindels P, Witteman J, Bierma-Zeinstra S. Association of atherosclerosis with presence and progression of osteoarthritis: the Rotterdam Study. Annals of the rheumatic diseases. 2012:annrheumdis-2011-201178.
Van Manen MD, Nace J, Mont MA. Management of primary knee osteoarthritis and indications for total knee arthroplasty for general practitioners. The Journal of the American Osteopathic Association. 2012;112:709-15.
Cram P, Lu X, Kates SL, Singh JA, Li Y, Wolf BR. Total knee arthroplasty volume, utilization, and outcomes among Medicare beneficiaries, 1991-2010. Jama. 2012;308:1227-36.
Lin C-F, Liu J-C, Chi N-F, Chiu Y-S, Hsu H-S, Chien L-N. The effect of osteoarthritis on 1-year risk of ischemic heart disease following total knee arthroplasty. The Journal of arthroplasty. 2014;29:2447-51. e1.
Ravi B, Croxford R, Austin PC, Lipscombe L, Bierman AS, Harvey PJ, Hawker GA. The relation between total joint arthroplasty and risk for serious cardiovascular events in patients with moderate-severe osteoarthritis: propensity score matched landmark analysis. 2013.
Goff DC, Lloyd-Jones DM, Bennett G, Coady S, D’Agostino RB, Gibbons R, Greenland P, Lackland DT, Levy D, O’Donnell CJ. 2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Journal of the American College of Cardiology. 2014;63.
Yoshimura N, Muraki S, Oka H, Tanaka S, Kawaguchi H, Nakamura K, Akune T. Accumulation of metabolic risk factors such as overweight, hypertension, dyslipidaemia, and impaired glucose tolerance raises the risk of occurrence and progression of knee osteoarthritis: a 3-year follow-up of the ROAD study. Osteoarthritis and Cartilage. 2012;20:1217-26.
Libby P, Ridker PM. Inflammation and atherosclerosis: role of C-reactive protein in risk assessment. The American journal of medicine. 2004;116:9-16.
Felson DT. Osteoarthritis of the knee. New England Journal of Medicine. 2006;354:841-8.
Sowers M, Jannausch M, Stein E, Jamadar D, Hochberg M, Lachance L. C-reactive protein as a biomarker of emergent osteoarthritis. Osteoarthritis and Cartilage. 2002;10:595-601.
Lorenz MW, Markus HS, Bots ML, Rosvall M, Sitzer M. Prediction of clinical cardiovascular events with carotid intima-media thickness a systematic review and meta-analysis. Circulation. 2007;115:459-67.
Stein JH, Korcarz CE, Hurst RT, Lonn E, Kendall CB, Mohler ER, Najjar SS, Rembold CM, Post WS. Use of carotid ultrasound to identify subclinical vascular disease and evaluate cardiovascular disease risk: a consensus statement from the American Society of Echocardiography Carotid Intima-Media Thickness Task Force endorsed by the Society for Vascular Medicine. Journal of the American Society of Echocardiography. 2008;21:93-111.
Lawrence J. Hypertension in relation to musculoskeletal disorders. Annals of the rheumatic diseases. 1975;34:451-6.
Hart DJ, Doyle DV, Spector TD. Association between metabolic factors and knee osteoarthritis in women: the Chingford Study. The Journal of rheumatology. 1995;22:1118-23.
Ridker PM. Clinical application of C-reactive protein for cardiovascular disease detection and prevention. Circulation. 2003;107:363-9.
Miller D, Forrester K, Hart DA, Leonard C, Salo P, Bray RC. Endothelial dysfunction and decreased vascular responsiveness in the anterior cruciate ligament-deficient model of osteoarthritis. Journal of applied physiology. 2007;102:1161-9.
Jungmann PM, Kraus MS, Alizai H, Nardo L, Baum T, Nevitt MC, McCulloch CE, Joseph GB, Lynch JA, Link TM. Association of metabolic risk factors with cartilage degradation assessed by T2 relaxation time at the knee: data from the osteoarthritis initiative. Arthritis care & research. 2013;65:1942-50.