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Circulating C reactive protein in osteoarthritis: a systematic review and meta-analysis
  1. Xingzhong Jin1,
  2. Julieta Ruiz Beguerie2,
  3. Weiya Zhang3,
  4. Leigh Blizzard1,
  5. Petr Otahal1,
  6. Graeme Jones1,
  7. Changhai Ding1,4,5
  1. 1Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tasmania, Australia
  2. 2Department of Dermatology, Austral University Hospital, Buenos Aires, Argentina
  3. 3Academic Rheumatology, University of Nottingham, Nottingham, UK
  4. 4Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
  5. 5Arthritis Research Institute, 1st Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
  1. Correspondence to Prof Changhai Ding, Menzies Research Institute Tasmania, University of Tasmania, Private Bag 23, Hobart, TAS 7000, Australia; Changhai.Ding{at}


Background There is emerging evidence that the development and progression of osteoarthritis (OA) is associated with inflammation. C reactive protein (CRP), a systemic marker for inflammation, may be elevated in OA patients but the evidence is conflicting.

Objective To systematically review the literature for the relationship between serum CRP levels measured by a high sensitivity method (high sensitive CRP (hs-CRP)) and OA, as well as the correlation between circulating CRP levels and OA phenotypes.

Methods MEDLINE, EMBASE and CINAHL databases were systematically searched from January 1992 to December 2012. Studies were included when they met the inclusion criteria and data from studies were extracted. Two independent reviewers assessed study quality using a modified Newcastle-Ottawa Quality Assessment Scale. Meta-analyses were performed to pool available data from included studies.

Results 32 studies met the inclusion criteria. Serum hs-CRP levels in OA were modestly but statistically significantly higher than controls (mean difference=1.19 mg/L, 95% CI 0.64 to 1.73, p<0.001) with significant heterogeneity between studies. Levels were significantly associated with pain (r=0.14, 95% CI 0.09 to 0.20, p<0.001) and decreased physical function (r=0.25, 95% CI 0.13 to 0.39, p<0.001). No significant associations were found between hs-CRP levels and radiographic OA.

Conclusions Low-grade systemic inflammation may play a greater role in symptoms rather than radiographic changes in OA.

  • Osteoarthritis
  • Inflammation
  • Epidemiology

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