Article Text

Download PDFPDF
Urinary CTX-II levels are associated with radiographic subtypes of osteoarthritis in hip, knee, hand, and facet joints in subject with familial osteoarthritis at multiple sites: the GARP study
  1. I Meulenbelt1,
  2. M Kloppenburg2,3,
  3. H M Kroon4,
  4. J J Houwing-Duistermaat5,
  5. P Garnero6,
  6. M-P Hellio Le Graverand7,
  7. J DeGroot8,
  8. P E Slagboom1
  1. 1Department of Molecular Epidemiology, Leiden University Medical Centre, Leiden, Netherlands
  2. 2Department of Rheumatology, Leiden University Medical Centre
  3. 3Department of Clinical Epidemiology and Haematology, Leiden University Medical Centre
  4. 4Department of Radiology, Leiden University Medical Centre
  5. 5Department of Medical Statistics, Leiden University Medical Centre
  6. 6Synarc, Lyon, France
  7. 7Pfizer Global Research and Development, Croton, Connecticut, USA
  8. 8Business Unit Biomedical Research, TNO Quality of Life, Leiden
  1. Correspondence to:
    Dr Ingrid Meulenbelt
    Leiden University Medical Centre, Section of Molecular Epidemiology, Wassenaarseweg 72, 2333 AL Leiden, Netherlands; i.meulenbelt{at}


Objective: To assess the relation between the urinary concentrations of type II collagen C-telopeptide (UCTX-II) and radiographic signs of osteoarthritis (ROA) in the GARP (Genetics, Arthrosis and Progression) study.

Methods: UCTX-II levels were measured in GARP study participants, who are sibling pairs predominantly with symptomatic osteoarthritis at multiple sites. Kellgren and Lawrence scores were used to assess ROA in the knees, hips, hands, and vertebral facet joints, and spinal disc degeneration. A proportionate score was made for each joint location, based on the number of joints with ROA. The sum total ROA score represents a measure of cartilage abnormalities within each patient. By using linear mixed models the total ROA score and the joint site specific ROA scores were correlated with the UCTX-II level.

Results: In 302 subjects the mean (SD) and median (range) for UCTX-II were 265 (168) and 219 (1346) ng/mmol creatine, respectively. There was a significant association between the total ROA score and UCTX-II levels. Subsequent multivariate analysis showed that the joint site specific ROA score at all joint sites, except for spinal disc degeneration, contributed independently to this association.

Conclusions: The total ROA score of GARP patients, representing cartilage abnormalities at the most prevalent ROA joint locations, showed an excellent correlation with UCTX-II levels. The specific ROA scores at the hip, hand, facet, and knee joints additively and independently explained this association. Even in patients with osteoarthritis at multiple sites, UCTX-II may be a sensitive quantitative marker of ROA.

  • CMC, carpometacarpal joint
  • CTX-II, C-terminal cross linking telopeptide of type II collagen
  • DIP, distal interphalangeal joint
  • GARP, Genetics, Arthrosis and Progression
  • MCP, metacarpophalangeal joint
  • PIP, proximal interphalangeal joint
  • ROA, radiographic signs of osteoarthritis
  • UCTX-II, urinary level of type II collagen C-telopeptide
  • osteoarthritis
  • CTX-II
  • GARP study
  • biomarker

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.


  • Published Online First 11 August 2005