Evaluation of the Relationship Between Knee Osteoarthritis and Inflammation: The Role of Hematologic Indices

Year 2024, Volume: 57 Issue: 2, 53 - 58, 31.08.2024

Nadide Koca

https://doi.org/10.20492/aeahtd.1403954

Abstract

AIM: The aim of this study is to evaluate the relationship between knee osteoarthritis (OA) and inflammation, and to assess the connection between inflammatory parameters and the severity of OA. Additionally, it aims to investigate the usability of hematological indices in this context.
MATERIAL AND METHOD: A total of 257 participants (127 with knee OA, 130 controls) were examined. Patients with knee OA were staged according to the Kellgren-Lawrence System. Demographic characteristics of participants in both the OA and control groups, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and complete blood count data were used to calculate neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), monocyte/lymphocyte ratio (MLR), systemic immune index (SII), systemic immune response index (SIRI), and neutrophil/hemoglobin-lymphocyte index (NHL). All data between the groups were statistically compared. Additionally, two subgroups were formed based on knee OA stages: stages 1-3 (mild to moderate knee OA) and stage 4 (advanced knee OA). Hematologic indices between these two subgroups were compared.
RESULTS: The NHL score was significantly higher in the knee OA group compared to the control group (p<0.01). Furthermore, in the comparison between early-stage knee OA and advanced-stage knee OA, PLR (p<0.01), MLR (p<0.05), SII (p<0.01), and SIRI (p<0.05) indices were found to be significantly higher in advanced-stage knee OA compared to early-stage knee OA.
CONCLUSION: The NHL index may be a useful parameter for the early diagnosis of OA. In our study, a relationship was found between the PLO, MLO, SII, and SIRI indices and the progression of knee OA. Our results suggest that there may be an association between inflammation and knee OA.

Keywords

Knee Osteoarthritis (OA), Inflammation Indices, Systemic Immune Index (SII), Systemic Immune Response Index (SIRI).

Diz Osteoartriti ve İnflamasyon Arasındaki İlişkinin Değerlendirilmesinde Hematolojik İndekslerin Rolü

Abstract

AMAÇ: Bu çalışmanın amacı, diz osteoartriti (OA) ile inflamasyon arasındaki ilişkiyi ve inflamatuar parametrelerin OA şiddeti ile olan bağlantısını değerlendirmektir. Ayrıca, bu bağlamda hematolojik indekslerin kullanılabilirliğini incelemeyi hedeflemektedir.
GEREÇ VE YÖNTEM: Toplam 257 katılımcı (127 diz OA, 130 kontrol) incelendi. Diz OA'li hastalar Kellgren-Lawrence Sistemi'ne göre evrelendirildi. Hem OA hem de kontrol grubundaki katılımcıların demografik özellikleri elde edildi. Eritrosit sedimantasyon hızı (ESH), C-reaktif protein (CRP) kaydedildi ve tam kan sayımı verileri kullanılarak nötrofil/lenfosit oranı (NLO), platelet/lenfosit oranı (PLO), monosit/lenfosit oranı (MLO), sistemik immün indeks (SII), sistemik immün response indeks (SIRI) ve nötrofil/hemoglobin-lenfosit indeksi (NHL) hesaplandı. Gruplar arasındaki tüm veriler istatistiksel olarak karşılaştırıldı. Ayrıca, diz OA evrelerine göre iki alt grup oluşturuldu; evre 1-3 (hafif-orta diz OA) ve evre 4 (ileri diz OA). Bu iki alt grup arasındaki hematolojik indeksler karşılaştırıldı.
BULGULAR: Diz OA'li grupta NHL skoru kontrol grubuna göre anlamlı olarak yüksekti (p<0.01). Ayrıca, erken evre diz OA ile ileri evre diz OA arasında yapılan karşılaştırmada ileri evre diz OA'de PLO (p<0.01), MLO (p<0.05), SII (p< 0,01) ve SIRI (p<0.05) indeksleri erken evre diz OA'ne göre anlamlı olarak yüksek bulundu.
SONUÇ: NHL indeksi, erken evre OA tanısında kullanılabilir bir parametre olabilir. Çalışmamızda PLO, MLO, SII ve SIRI indeksleri ile diz OA progresyonu arasında ilişki bulunmuştur. Sonuçlarımız, inflamasyon ile diz OA arasında bir birliktelik olabileceğini düşündürmektedir.

Keywords

Diz Osteoartriti (OA), İnflamasyon İndeksleri, Sistemik İmmün İndeks (SII), Sistemik İmmün Response İndeks (SIRI).

Ethical Statement

Çalışma protokolü, Helsinki Deklarasyonu Prensipleri’ ne uygun planlanmış ve Ankara Eğitim ve Araştırma Hastanesi yerel etik kurulundan alınan onayla uygulanmıştır (07.09.2023 tarihinde, E-23-1371 no’lu etik kurul kararı).

Supporting Institution

Yazarlar arasında çıkar çatışması mevcut değildir.

Thanks

Hiçbir kişi/kuruluş çalışmayı finansal olarak desteklememiştir.

References

• 1- Büyükavcı R, Aktürk S, Sağ S. Comparison of blood platelet distribution width and neutrophil-lymphocyte ratio in patients with different grades of knee osteoarthritis. J Back Musculoskelet Rehabil. 2018;31(6):1035-1039.
• 2- Loeser RF, Goldring SR, Scanzello CR, Goldring MB. Osteoarthritis: a disease of the joint as an organ. Arthritis Rheum. 2012;64(6):1697- 707.
• 3- Trams E, Malesa K, Pomianowski S, Kaminski R. Role of Platelets in Osteoarthritis-Updated Systematic Review and Meta-Analysis on the Role of Platelet-Rich Plasma in Osteoarthritis. Cells. 2022;11(7):1080.
• 4- Xu Y, He H, Zang Y, Yu Z, Hu H, Cui J, et al. Systemic inflammation response index (SIRI) as a novel biomarker in patients with rheumatoid arthritis: a multi-center retrospective study. Clin Rheumatol. 2022;41(7):1989-2000.
• 5- Wu J, Yan L, Chai K. Systemic immune-inflammation index is associated with disease activity in patients with ankylosing spondylitis. J Clin Lab Anal. 2021;35(9):e23964.
• 6- Chaney S, Vergara R, Qiryaqoz Z, Suggs K, Akkouch A. The Involvement of Neutrophils in the Pathophysiology and Treatment of Osteoarthritis. Biomedicines. 2022;10(7):1604.
• 7- de Lange-Brokaar BJ, Ioan-Facsinay A, van Osch GJ, Zuurmond AM, Schoones J, Toes RE, et al. Synovial inflammation, immune cells and their cytokines in osteoarthritis: a review. Osteoarthritis Cartilage. 2012;20(12):1484-99.
• 8- Hu B, Yang XR, Xu Y, Sun YF, Sun C, Guo W, et al. Systemic immune-inflammation index predicts prognosis of patients after curative resection for hepatocellular carcinoma. Clin Cancer Res. 2014;20(23):6212-22.
• 9- Xia Y, Xia C, Wu L, Li Z, Li H, Zhang J. Systemic Immune Inflammation Index (SII), System Inflammation Response Index (SIRI) and Risk of All-Cause Mortality and Cardiovascular Mortality: A 20-Year Follow-Up Cohort Study of 42,875 US Adults. J Clin Med. 2023;12(3):1128.
• 10- Cheng W, Bu X, Xu C, Wen G, Kong F, Pan H, et al. Higher systemic immune-inflammation index and systemic inflammation response index levels are associated with stroke prevalence in the asthmatic population: a cross-sectional analysis of the NHANES 1999-2018. Front Immunol. 2023;14:1191130.
• 11- Satis S. New Inflammatory Marker Associated with Disease Activity in Rheumatoid Arthritis: The Systemic Immune-Inflammation Index. Curr Health Sci J. 2021;47(4):553-557.
• 12- Choe JY, Lee CU, Kim SK. Association between Novel Hematological Indices and Measures of Disease Activity in Patients with Rheumatoid Arthritis. Medicina (Kaunas). 2023;59(1):117.
• 13- Altman R, Asch E, Bloch D, Borenstein D, Brandt K, Christy W, et al. Development of criteria for the classification and reporting of osteoarthritis. Classification of osteoarthritis of the knee. Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association. Arthritis Rheum 1986;29(8):1039-49
• 14- Kohn MD, Sassoon AA, Fernando ND. Classifications in Brief: Kellgren-Lawrence Classification of Osteoarthritis. Clin Orthop Relat Res. 2016;474(8):1886-93.
• 15- Robinson WH, Lepus CM, Wang Q, Raghu H, Mao R, Lindstrom TM, et al. Low-grade inflammation as a key mediator of the pathogenesis of osteoarthritis. Nat Rev Rheumatol. 2016;12(10):580-92.
• 16- Ni F, Zhang Y, Peng X, Li J. Correlation between osteoarthritis and monocyte chemotactic protein-1 expression: a meta-analysis. J Orthop Surg Res. 2020;15(1):516.
• 17- Nedunchezhiyan U, Varughese I, Sun AR, Wu X, Crawford R, Prasadam I. Obesity, Inflammation, and Immune System in Osteoarthritis. Front Immunol. 2022;13:907750.
• 18- Karpuz S, Yılmaz R, Özkan M, Tuncez İH, Kalaoğlu E, Yılmaz H. Is There Any Correlation Between the Systemic Immune Inflammatory Index and Disease Severity in Knee Osteoarthritis? Genel Tıp Derg. 2023;33(3):305-308.
• 19- Ioniţescu M, Vermeşan D, Haraguș H, Suciu O, Todor A, Dumitrașcu CV, et al. Association of neutrophil to lymphocyte ratio with patient reported outcomes in knee osteoarthritis. Applied Sciences. 2020;10(22):8173.
• 20- Chawla A, Paraoan V, Rabiu R, Clark T, Powell S, Grammatopoulos D, et al. Determining the stress biomarker profile in patients undergoing total knee replacement and the relationship with outcome at 12 months. Knee. 2019;26(6):1379-1385.
• 21- Mobasheri A, Henrotin Y. Biomarkers of (osteo)arthritis. Biomarkers 2016; 20(8): 513–518.
• 22- Nees TA, Rosshirt N, Zhang JA, Reiner T, Sorbi R, Tripel E, et al. Synovial Cytokines Significantly Correlate with Osteoarthritis-Related Knee Pain and Disability: Inflammatory Mediators of Potential Clinical Relevance. J Clin Med. 2019;8(9):1343.
• 23- Qian H, Chen R, Wang B, Yuan X, Chen S, Liu Y, et al. Associations of Platelet Count with Inflammation and Response to Anti-TNF-α Therapy in Patients with Ankylosing Spondylitis. Front Pharmacol. 2020;11:559593.
• 24- Wang S, Yang X, Yu Z, Du P, Cao Y, Ji Y, et al. The values of systemic immune-inflammation index and neutrophil-lymphocyte ratio in predicting testicular germ cell tumors: A retrospective clinical study. Front Oncol. 2022;12:893877.
• 25- Mozos I, Malainer C, Horbańczuk J, Gug C, Stoian D, Luca CT, et al. Inflammatory Markers for Arterial Stiffness in Cardiovascular Diseases. Front Immunol. 2017;8:1058.
• 26- Ahbap E, Sakaci T, Kara E, Sahutoglu T, Koc Y, Basturk T, et al. Neutrophil-to-lymphocyte ratio and platelet-tolymphocyte ratio in evaluation of inflammation in end-stage renal disease. Clin Nephrol. 2016 Apr;85(4):199-208.
• 27- Hao X, Li D, Wu D, Zhang N. The Relationship between Hematological Indices and Autoimmune Rheumatic Diseases (ARDs), a Meta- Analysis. Sci Rep. 2017;7(1):10833.
• 28- Zhou Q, Liu J, Xin L, Hu Y, Qi Y. Systemic inflammation response index as an emerging biomarker in osteoarthritis patients: a bibliometric and large sample retrospective investigation. Clin Exp Rheumatol. 2024;42(1):92-103.
• 29- Taşoğlu Ö, Bölük H, Şahin Onat Ş, Taşoğlu İ, Özgirgin N. Is blood neutrophil-lymphocyte ratio an independent predictor of knee osteoarthritis severity? Clin Rheumatol. 2016;35(6):1579-83.
• 30- Domazet SL, Olesen TB, Stidsen JV, Svensson CK, Nielsen JS, Thomsen RW, et al. Low-grade inflammation in persons with recently diagnosed type 2 diabetes: The role of abdominal adiposity and putative mediators. Diabetes Obes Metab. 2024;26(6):2092-2101.
• 31- Mebratu YA, Jones JT, Liu C, Negasi ZH, Rahman M, Rojas-Quintero J, et al. Bik promotes proteasomal degradation to control low-grade inflammation. J Clin Invest. 2023;134(4):e170594.
• 32- Knapik M, Żelazo DA, Osowiecka K, Krajewska-Włodarczyk M. Efficacy of Anti-Interleukin-1 Therapeutics in the Treatment of Knee Osteoarthritis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials from the Years 2000 to 2023. J Clin Med. 2024;13(10):2859.
• 33- Terkawi MA, Ebata T, Yokota S, Takahashi D, Endo T, Matsumae G, et al. Low-Grade Inflammation in the Pathogenesis of Osteoarthritis: Cellular and Molecular Mechanisms and Strategies for Future Therapeutic Intervention. Biomedicines. 2022;10(5):1109.
• 34- Raveendran D, Perry LA, Bucknill A, Liu Z. The Significance of Neutrophil Lymphocyte Ratio, Platelet Lymphocyte Ratio, and Red Cell Distribution Width in Osteoarthritis: A Systematic Review and Meta-Analysis. JBJS Journal of Orthopaedics for Physician Assistants. 2023;11(4):e23.
• 35- Koca TT, Baykara M, Koçyiğit BF. Relation of complete blood count parameters and derivatives with radiologic staging of knee osteoarthritis. Cukurova Medical Journal 2019;44(4):1364-70.
• 36- Karataş NM, Karataş G, Türk İ. Relationship Between Inflammation Parameters Which Are Obtained From Blood Count And Knee Osteophytes. Akdeniz Medical Journal 2021;7(3):400-406.
• 37- Gao K, Zhu W, Liu W, Ma D, Li H, Yu W, et al. Diagnostic value of the blood monocyte-lymphocyte ratio in knee osteoarthritis. J Int Med Res. 2019;47(9):4413-4421.
• 38- Ustundag Y, Huysal K, Gecgel SK, Unal D. Relationship between C-reactive protein, systemic immune-inflammation index, and routine hemogram-related inflammatory markers in low-grade inflammation. Int J Med Biochem. 2018;1(1):24-8.
• 39- Ionitescu M, Vermesan D, Suciu O, Deleanu B, Abu-Awwad A, Dumitrascu VC, et al. Association of Neutrophil to Lymphocyte Ratio with Disease Severity and Joint Effusion in Patients with Early Stage Knee Osteoarthritis. Rev Chim. 2020;71(7):464-468.
• 40- Fu H, Qin B, Hu Z, Ma N, Yang M, Wei T, et al. Neutrophil- and platelet-to-lymphocyte ratios are correlated with disease activity in rheumatoid arthritis. Clin Lab. 2015;61(3-4):269-73.
• 41- Shi J, Zhao W, Ying H, Du J, Chen J, Chen S, et al. The relationship of platelet to lymphocyte ratio and neutrophil to monocyte ratio to radiographic grades of knee osteoarthritis. Z Rheumatol. 2018;77(6):533-537.
• 42- Zhou S, Thornhill TS, Meng F, Xie L, Wright J, Glowacki J. Influence of osteoarthritis grade on molecular signature of human cartilage. J Orthop Res. 2016;34(3):454-62.