Article Text

AB1005 Glycosaminoglycan in Synovial Fluid of Osteoarthritis Patients Validates Kellgren-Lawrence Score as a Useful Indicator for Disease Progression and Cartilage Degradation
  1. P. Kulkarni1,
  2. S. Koppikar1,
  3. A. Mahajan2,
  4. S. Deshpande2,
  5. A. Harsulkar1
  1. 1Cell and Molecular Biology, Interactive Research School For Health Affairs (IRSHA), Bharati Vidyapeeth University, Pune, India
  2. 2Depatment of Orthopaedics, Bharati Hospital, Bharati Vidyapeeth University, Pune, India, Pune, India


Background Cartilage is a marvel design, which handles a remarkable pressure in weight bearing joints yet facilitates resilient movement. Osteoarthritis (OA) is a disease characterised by progressive degeneration of cartilage, which is a dual result of inflammation and associated molecular damage.

In recent years, use of several biochemical-markers has been emphasized, which provide pathology specific information. Being a degeneration product of cartilage matrix, glycosaminoglycan (GAG) has a merit as direct measure of cartilage degenerative changes. However, invasive nature and associated cross-talk explaining multidimensional role of these markers always limit its prognostic value for disease diagnosis. On the other side, most of the Orthopaedic Clinicians use Kellgren-Lawrence Score (KL) as a metric for OA diagnosis and progression, giving weightage to Joint Space Narrowing (JSN) and Osteophyte formation.

Objectives Linkage between KL-score and GAG levels is hypothesized. KL-score is based on visual approximate estimation of joint space narrowing, while GAG is a direct biochemical value.

Methods We analysed twenty-four synovial fluid (SF) samples obtained from OA patients for their GAG values using DMMB based assay [1]. The patients were graded among KL-score 1-4, based upon their radiographic features by a practicing qualified Orthopaedic surgeon. The results were evaluated by “paired t” test for statistical significance.

Results All the patients revealed high GAG value compared to normal, obtained from our non-OA patient data-base (78.4±30.1μg/ml) with matching ethnicity. Interestingly, an established correlation was found between KL-score and GAG levels. On one end, when compared between KL-scores, significant cartilage loss was observed in between Grade 1 & 2, Grade 1 & 4 and Grade 2 & 4, degradation of cartilage between Grade 2 & 3, Grade 3 &4 remains non-significant. KL-score 2 & 3 shares similar radiographic characters, more prominent in grade 3, thus indicating more disease severity.

Conclusions KL-score system is often criticized for its non-clarity of inter-grading during disease-progression and overemphasis on osteophyte formation, which is less involved in OA pathogenesis per se. Moreover, visual estimation of JSN is also the source of criticism [2]. Despite of its limitations, GAG levels in SFs validated KL-score system as a useful indicator for cartilage degeneration and OA progression in studied patients.


  1. Sumantran V N, Joshi A K, Boddul S et al: Antiarthritic Activity of a Standardized, Multiherbal, Ayurvedic Formulation containing Boswellia serrata: In Vitro Studies on Knee Cartilage from Osteoarthritis Patients. Phytother Res 2011; 25: 1375–1380.

  2. Brandt K, Fife R, Braunstein E et al: Radiographic grading of the severity of knee osteoarthritis: Relation of the kellgren and lawrence grade to a grade based on joint space narrowing, and correlation with arthroscopic evidence of articular cartilage degeneration: Arthritis & Rheumatism 1991: 34 (11): 1381-1386.

Disclosure of Interest None declared

DOI 10.1136/annrheumdis-2014-eular.5154

Statistics from

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.