الفهرس 
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Abstract
Osteoarthritis (OA) is the most prevalent joint disease-causing remarkable disability in most adults >55 years of age (Issa and Sharma, 2006).The knee is the most affected joint, manifested with pain, stiffness, and considerable functional disability especially in women (Petterson et al., 2007, Blagojevic et al., 2010). If OA can be detected during the early stages, OA patients can be given early treatment. Therefore, the search for an early diagnostic tool of OA is an urgent task for OA diagnosis and treatment (Huang et al., 2018).Many biomarkers have been investigated to study the prognosis and pathogenesis of OA (Lotz et al., 2014). One such biomarker is C-telopeptide fragments of type II collagen (CTX-II) which is created during articular cartilage breakdown and excreted in urine. Urinary CTX-II has been shown to be elevated in correlation with the presence and severity of knee OA (KOA) (Røtterud et al., 2014).This study aimed to evaluate the difference in urinary CTX-II levels between patients with early KOA and healthy controls, to determine the correlation between urinary CTX-II levels, radiographic diagnosis of OA, and patient-reported outcomes. This study was carried out on 45 patients (8males and 37 females) suffering from early KOA attending the Outpatient Clinic of Physical Medicine, Rheumatology and Rehabilitation Department, Mansoura University Hospital and 45 healthy controls of matched age and sex . They were all diagnosed according to 2016 ACR clinical and radiological classification criteria for KOA.Inclusion Criteria: This study included adult male or female with age 40 years or above and diagnosed with KOA according to Kellgren-Lawrence (KL) score (knee joint was graded K-L 0 or 1 at least in one knee joint). Patients in OA group with clinically and radiographically diagnosis of KOA based on the 2016 ACR revised Criteria for early diagnosis of KOA. Exclusion Criteria: We excluded from this study any subjects with age less than 40 years old, with KL score > grade 1, with history of arthroscopy within the past 6 months, with current or previous acute inflammatory joint disease or any other rheumatic diseases, with history of intake of any osteoarthritis directed medication or hyaluronic acid injections within 6 months prior to inclusion, with acute major trauma, with history of chronic kidney disease (glomerular filtration rate (GFR) < 30 ml/min) and with current or previous treatment with bisphosphonates.All patients in this study were subjected to
•History taking•Physical Examination•Radiological Investigations: all patients were undergone bilateral weight bearing anteroposterior x-ray of the knee. They were assessed according to Kellgren-Lawrence score graded from (0-4) (Kellgren and Lawrence, 1957). Anteroposterior and lateral view of spine and hips will be taken to exclude O.A or spondylosis of spine and hips.•Laboratory investigations (CBC, ESR, CRP , Serum creatinine ,Serum uric acid ,Synovial fluid aspiration & examination in patients with effusion ,Urinary CTX-II).from this study we found that:The mean WOMAC score in the cases group was 16.96 ± 9.08 and the median score was 16 with range between 4 and 40. The mean pain at rest score in the cases group was 0.67 ± 1.11 and the median score was 0 with range between 0 and 4. The mean pain at activity score in the cases group was 3.67 ± 1.83 and the median score was 3 with range between 1 and 3. The KL score was 1 in all the cases. All the cases had Joint crepitus on palpation. There were 41 cases (91.1%) with knee tenderness, 30 cases (66.7%) with Knee pain induced by movement and there were 3 cases (6.7%) with limited range of movement.The median ESR in the cases group was 15 mm/h (range: 4-30) and in the control group was 13 mm/h (range: 4-30), with no statistically significant difference between the two groups (p= 0.621).The median CRP in the cases group was 2.5 mg/dl (range: 1.2-4.6) and in the control group was 2.3 mg/dl (range: 1.2-5.8), with no statistically significant difference between the two groups (p= 0.381). The median CTXII level in the cases group was 224.3 (range: 59.4-362.8) and in the control group was 55.4 (range: 0-141.5). The level of CTXII was statistically significantly higher in the cases group (p < 0.001).In the cases group, there was a statistically significant positive correlation between Urinary CTXII with WOMAC, Pain at activity score, CRP and ESR. Other variables didn’t show a statistically significant correlation.The best cutoff point of Urinary CTXII to identify osteoarthritis cases from the control was > 85.25. This point showed high degree of sensitivity and specificity, with high statistically significant value (p < 0.001).