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Research Article | Volume 4 Issue 1 (Jan-June, 2024) | Pages 1 - 6
C-Reactive Protein, Vitamin D and Calcium as Biomarkers for the Diagnosis in some Osteoarthriris Patients who Attending Al-Refai Teaching Hospital
1
Department of Pathological Analysis, College of Sciences, University of Sumer, Rifai, Iraq, 64005
Under a Creative Commons license
Open Access
Received
Jan. 5, 2024
Revised
March 2, 2024
Accepted
May 7, 2024
Published
June 30, 2024
Abstract

Background: Osteoarthritis (OA) is the main predominant type of arthritis and it is further established in the old ages. Person who suffers from OA naturally experiences joint stiffness and anxiety next time of rest or inactivity. Aims: Of the present study were evaluation of the levels of C-reactive protein, Calcium, and Vitamin D3 for some OA patients who attended Al-Refai Teaching Hospital. Methods: The current study was conducted at Al-Rifai Teaching Hospital from September 2023 to May 2024 .100 different samples were collected, males and females, from patients who visited the consultation at Al-Rifai General Hospital / Joints. Results were compared with the control group, which consisted of (100 different samples of males and females).  Results: The present result showed that the percentage of females suffering from OA was higher than the percentage of males, especially in the age group older than 36 years. The results of the current study showed no significant difference in Ca level in OA patients. The results of the current study also indicated a decrease in the level of vitamin D in the patient’s group was higher than in the healthy group. The results of the current study also indicated that 70% of patients had high level of C-reactive protein, on other hand the levels of vitamin D3in patients group were low in patients compared with control group Conclusions: According to our results we concluded that there was positive association between each of vitamin D and CRP with OA patients versus in control group but negative correlation between OA and Ca level.

Keywords
IMPORTANT

Key findings:

The study found that female OA patients outnumbered males, especially over age 36. It also showed no significant difference in calcium levels between OA patients and controls, but decreased vitamin D levels and increased C-reactive protein levels in OA patients compared to the healthy control group.

 

What is known and what is new?

What is known is that osteoarthritis (OA) is a common joint disorder, especially in older adults, and that vitamin D deficiency and inflammation, as indicated by elevated C-reactive protein, are associated with OA. What is new is the finding of an inverse association between serum calcium levels and radiographic knee OA in an Asian population, suggesting a potential protective role for calcium in OA development.

 

What is the implication, and what should change now?

The implication is that monitoring and managing vitamin D status and inflammation may be important for the prevention and treatment of osteoarthritis. Changes needed include further research to confirm the relationship between calcium, vitamin D, and CRP levels in OA, and the potential incorporation of these biomarkers into clinical guidelines for the comprehensive management of osteoarthritis.

INTRODUCTION

OA is a prolonged disorder that disturbs the joint and consequences in aberrations in the sub-chondral bone and cartilages and it is one of the main reasons for incapability [1, 2]. Established on analysis of 88 studies, females had a greater occurrence   than males and the incidence of worse develops with old age [3]. Develops in any joint through the body, but it almost generally disturbs the hip and knee, which is described by hyperplasia in bone at the border of below the cartilage and the joints, harsh tinny and articular cartilages, and inflammation and synovial swelling [4]. Divided into two kinds, which are idiopathic—denotes the declining alterations of joints that happen due to genetic disorders without known causes. It can be further divided into local, which disturbs one joint only whereas the general disturbs more than three or three joints. On the other hand, secondary is related with risk factors such as diet, obesity, rheumatoid arthritis, physical activities, diabetes, and other disorders linked to metabolism or bones [5, 6].

 

 Cytokines, such as Interleukin -1β, Interleukin-6 and Tumor Necrosis Factor - α, play important roles as a main pro-inflammatory action in [7]. Also, these cytokines raise the level of CRP in serum, which is a sign of systemic inflammation, it appears to be associated with the rise of pain in [8].

 

Vitamin D shows an essential role in many cellular functions as strength and mass of muscles. Its deficiency reduces receptor expression in skeletal muscle and damages the mass of muscles in old patients [9]. In individuals with OA [10] denoted that getting supplementation of Vit- D recovers physical performance and quality of life.

 

 Calcium is an important nutrient which shows a vital role in many physiological processes, including, neurotransmitter release, exocrine and endocrine secretion, blood clotting and muscle contraction [11]. There are many studies denoting relations between OA and level of serum calcium. But no relationship was established between the level of erum calcium and OA in these studies as [12].

MATERIALS AND METHODS

CRP Kit test: 

  CPR tests are useful for diagnosing neoplastic, infectious, and inflammatory disorders. An increase in inflammation or damage is correlated with progressive increases. Compared to ESR, CRP is a more sensitive and quick-responding biomarker. CRP can be used to track the effectiveness of anti-inflammatory medication therapy and identify early signs of postoperative wound infection.

 

Specimen Requirements:

Specimen which used in this test is serum. The methodology is agglutination on latex paper.

 

Vitamin D test

The test is an immune chromatography-established one step in vitro test. It is designed for the quantitatives determination of total Vit D)       

Ca test: The calcium analysis was performed by drawing blood from one of the veins in the patient’s arm for analysis in the laboratory using special devices.

RESULTS

- The studied groups (OA patients and control group) according to their age. 

 

  Table 1 showed the maximum percentage of OA patients in the age group (>36 years) and lowest group the age group (15-25). There is no significant difference between two groups (1)       

                                                                                            

Table-1: All studied groups (OA patients and healthy control) according to age.

Healthy group

 

OA patients

Age groups by years

 

 

19))

 (19)

15-25))

 

24))

 (21)

26-36))

 

(57)

(60)

>36 years 

 

Chi-Square

Value

Df

P-value

 

0.018

99

0.95

     

 

 

2- Distribution of the all studied groups according to sex.       

The results of the current study, presented a rise in the rate of females with OA  by a percentage of (75 %), while the rate of  males were ( 25%) , there were   significant differences between  them as seen in table (2).   

                                                          

Table (2) Distribution of OA  patients  group according to sex

Chi-Square

percentage

Sex

 

 

4.68

 

25%

Male 

 

75%

Female  

P-value=0.06

 

 

3 -Serum   CRP concentration in healthy and patient groups.

The levels of CRP were high in patients sera with OA, matched with the control group, as the result of   of CRP positive was  ( 30% ) compared to the negative  result (70% ), as in table ( 3)

 

 

Table (3) Serum   CRP    in OA serum patients’ group.

Chi-Square

percentage

 patients’ group

 

3.68

 

 30%

 +ve CRP

 

70 % 

-ve CRP 

P-value=0.05

 

 

4 -Serum   vit D3 concentration in the healthy and patient group. 

 The current study showed significant difference in the rate of concentrations for  vit D3 in patients sera with OA , matched with control group , as the rate of concentration of  vit D3 in  patients (10.5 ng/ml ) compared to the control group (33 ng/ml ) with ( 0.000), significant difference , as in table (4).

 

 

Table(4) Serum   Vit D3  concentration in studied groups

P-value   

 

T value

Df

Mean   

No of cases

Subject

               Parameter

0.000 s

 

 

 

 

 

4.17 

 

 

 

99

     30

100

 

control

 

 Vit D3

10.5

100

 

patients

 

 

5-Ca concentration in healthy and  patients group

 The current study showed no significant difference in the rate of concentrations for  Ca in OA patients compared with the control group , as the rate of concentration of Ca in patients (2.2mMol/L ) while in the control group (2.5 mMol/L),as in table ( ).

 

 

Table (5) Ca concentration in  studied groups.

Mean   

No of cases

Subject

               Parameter

             2.5

100

 

control

 

Ca

2.2     

100

 

patients

DISCUSSION

The results of the current study showed that the age group most susceptible to OA is those older than 36 years, and the reason for this result is that with increased age, a person’s immunity decreases. Our result agrees with [13] Another result that appeared to us is that the percentage of females suffering from OA is higher than males. Our result agrees with [14]. Our interpretation perhaps because women are more susceptible than men to developing arthritis diseases, one theory has stated that the female sex hormones, estrogen and progesterone, play a role in this.  

                                                                                         

   As for the CRP result, the results showed that the percentage of positive results for the above test show significant differences. 

 

  Realizing that inflammation is not unique to RA and the other traditional inflammatory arthritides may be the first step towards comprehending OA as an inflammatory illness. Using OA tissues and fluids as a comparison, early RA research found much higher amounts of inflammatory proteins in RA [15, 16]. Our result about the level of vitamin D showed a low level of it in OA patients   matched with the healthy group. In older ages the capability of humans to produce vitamin D reductions [17]. Many additional factors  like don’t exposure to sunshine, malabsorptive diseases, and drugs that affect with absorption rises the vitamin D insufficiency\ deficiency in the old individual. Our result disagree with [18] who reported that no  correlation between levels of  vitamin D and occurrence of either hip or knee OA when its  study consist of 805 patients with follow-up for 22 years. While our result agree with [19] who denoted that vitamin D    insufficiency correlated with the knee OA development. Also our result agree with [20] who concluded that Reduced severity and functional status are linked to vitamin D insufficiency.

 

Finally, the result of Ca was inversely correlated with OA. There are several explanations for this result, the first of which is: there was no replication of calcium amount during follow-up. The second perhaps because of the small number of sample members. Our result agrees with [21]. Also no statistically significant differences in Ca levels was noticed between hand OA patients and healthy control groups As the researcher [22] pointed out.

CONCLUSIONS

  According to our results we concluded that there was a positive correlation between each vitamin D and CRP with OA patients versus in the control group but there was  negative correlation between OA and  Ca serum level.

 

Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

 

Conflict of Interest: The authors declare that they have no conflict of interest. 

 

 Ethical approval: The study was approved by the Institutional Ethics Committee of University of Sumer.

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