珍屯医学

标题: 骨关节炎 [打印本页]

作者: 大江 时间: 2018-10-21 00:31
标题: 骨关节炎
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在中指关节（称为Bouchard's节点）和最远的手指关节（称为Heberden's节点）形成硬旋钮是手中骨关节炎的常见特征。

骨关节炎（OA）是一种由关节软骨和下方骨质破坏引起的关节疾病。最常见的症状是关节疼痛和僵硬。最初，症状可能仅在运动后发生，但随着时间的推移可能会变得不变。其他症状可能包括关节肿胀，运动范围减小，以及当背部受到影响时，手臂和腿部无力或麻木。最常见的关节是靠近手指末端，拇指，颈部，下背部，膝盖和臀部的基部。身体一侧的关节往往比另一侧的关节受到更大的影响。通常这些症状会持续多年。它可以影响工作和日常活动。与其他类型的关节炎不同，只有关节通常受到影响。

原因包括既往关节损伤，关节或肢体发育异常以及遗传因素。超重，单腿长度不同，并且工作导致高水平关节压力的人的风险更大。骨关节炎被认为是由关节上的机械应力和低度炎症过程引起的。它随着软骨的丢失和下面的骨骼受到影响而发展。由于疼痛可能使其难以锻炼，因此可能会发生肌肉损失。诊断通常基于体征和症状，医学成像和其他测试偶尔用于支持或排除其他问题。与在骨关节炎中主要是炎性病症的类风湿性关节炎相反，关节不会变热或变红。

治疗包括运动，减轻关节压力的努力，支持组和止痛药。减少关节压力的努力包括休息和使用手杖。体重减轻可能有助于那些超重的人。疼痛药物可包括对乙酰氨基酚以及NSAID如萘普生或布洛芬。由于缺乏关于益处的信息以及成瘾和其他副作用的风险，通常不鼓励使用长期阿片类药物。如果疼痛干扰正常生活，尽管其他治疗，关节置换手术可能会有所帮助。人造关节通常持续10至15年。

骨关节炎是最常见的关节炎形式，影响约2.37亿（占总人口的3.3％）。在60岁以上的人群中，约有10％的男性和18％的女性受到影响。这是大约2％的残疾人生活的原因。在澳大利亚，约有190万人受到影响，[11]而在美国，有3千万至5,300万人受到影响。[12] [13]随着人们年龄的增长，它在男女两性中变得越来越常见。

目录
1 症状和体征
2 风险因素
2.1 主要
2.2 次要
3 病理生理学
4 诊断
4.1 分类
4.2 鉴别诊断
5 管理
5.1 改变生活方式
5.2 物理措施
5.3 药物治疗
5.4 手术
5.5 替代医学
6 流行病学
6.1 美国
7 历史
7.1 词源
8 研究
8.1生物标志物
9 参考文献

体征和症状

表明受影响最严重地区的女性身体轮廓
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骨关节炎最常发生在手（手指和拇指的末端），颈部，下背部，膝盖和臀部。
主要症状是疼痛，导致能力丧失和僵硬。长期活动通常会使疼痛加剧，休息时会减轻疼痛。僵硬在早晨是最常见的，并且通常在开始日常活动后持续不到30分钟，但可以在不活动期后返回。当受影响的关节移动时，骨关节炎会引起噼啪声（称为“crepitus”），特别是肩关节和膝关节。一个人也可能抱怨关节锁定和关节不稳定。由于疼痛和僵硬，这些症状会影响他们的日常活动。有些人报告与低温，高湿度或气压下降相关的疼痛增加，但研究结果好坏参半。

骨关节炎通常影响手，脚，脊柱和大的负重关节，例如臀部和膝盖，尽管理论上可以影响身体的任何关节。随着骨关节炎的进展，运动模式（例如步态）通常会受到影响。骨关节炎是膝关节积液最常见的原因。

在较小的关节，例如手指，硬骨扩大，称为Heberden节点（在远端指间关节上）或Bouchard节点（在近端指间关节上），可能形成，虽然它们不一定是疼痛，但它们确实限制了手指的运动显著。脚趾骨关节炎可能是导致拇趾囊肿形成的因素，使其呈红色或肿胀。

风险因素
机械应力对关节自修复不足造成的损伤被认为是骨关节炎的主要原因。这种压力的来源可能包括由先天性或致病原因引起的骨骼错位;机械损伤;体重过重;支撑关节的肌肉力量减弱;和周围神经受损，导致突然或不协调的运动。然而，运动，包括在没有受伤的情况下跑步，尚未发现增加膝关节骨性关节炎的风险。也没有找到破裂的指关节发挥作用。

主要
许多研究表明，在兄弟姐妹，特别是同卵双胞胎中，这种疾病的患病率更高，这表明遗传基础。虽然单一因素通常不足以引起疾病，但是大约一半的易感性变异已经归因于遗传因素。

随着早期人类祖先进化为两足动物，骨盆，髋关节和脊柱发生了变化，增加了骨关节炎的风险。此外，可能不会选择增加风险的遗传变异，因为通常问题仅在繁殖成功后发生。

骨关节炎的发展与先前关节损伤和肥胖的病史相关，尤其是对于膝盖。由于已经观察到与肥胖的相关性不仅对于膝盖而且对于非负重关节也是如此，并且体脂减少与症状缓解比与体重减轻更密切相关，已经表明可能存在代谢链接到身体脂肪而不是机械装载。

性激素水平的变化可能在骨关节炎的发展中起作用，因为它在绝经后女性中比在同龄男性中更普遍。对小鼠的研究发现，天然雌性激素具有保护作用，同时注射雄性激素二氢睾酮可降低保护作用。

职业
另见：职业病和职业伤害
在那些从事人工处理（例如提升），体力劳动，上班，以及在工作中攀爬任务（例如爬楼梯或梯子）的人中，发现患膝关节和髋关节骨关节炎的风险增加。特别是对于髋关节骨性关节炎，在弯曲或扭曲的位置工作的人中发现随着时间的推移发展的风险增加。特别是对于膝关节骨性关节炎，在跪或蹲位置工作的人中，与跪姿或下蹲姿势一起经历重度提升和站立工作时，发现风险增加。女性和男性对于骨关节炎的发展具有相似的职业风险。

次要
踝关节侧位X线扫描伴继发性骨关节炎

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侧
继发性X线扫描踝关节伴继发性骨关节炎

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前
一名82岁女性的踝关节继发性骨关节炎（由于旧骨折）
这种类型的骨关节炎是由其他因素引起的，但由此产生的病理与原发性骨关节炎相同：

尿黑尿症
先天性关节紊乱
糖尿病导致由于骨关节炎导致关节置换的风险加倍，并且糖尿病患者在比没有糖尿病的年龄更小的年龄时进行关节置换。
Ehlers-Danlos综合症
血色素沉着症和威尔森氏病
炎症性疾病（例如Perthes病），（莱姆病）和所有慢性关节炎形式（例如肋软骨炎，痛风和类风湿性关节炎）。在痛风中，尿酸晶体导致软骨以更快的速度退化。
由于事故或整形手术导致的关节或韧带（如ACL）受伤。
韧性恶化或不稳定可能是一个因素。
马凡综合症
肥胖
联合感染
病理生理学

健康髋关节的注释的例证

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健康的髋关节
髋关节的注释的例证与骨关节炎

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髋关节伴骨关节炎
虽然骨关节炎是一种退行性关节疾病，可能导致软骨损失和对其他关节组织的形态学损害，但在骨关节炎进展的早期阶段会发生更微妙的生化变化。健康软骨的含水量通过压缩力驱动出水和静水压力和渗透压吸入水来精确平衡。胶原纤维施加压缩力，而Gibbs–Donnan效应和软骨蛋白多糖产生渗透压，倾向于吸水。

然而，在骨关节炎发作期间，胶原基质变得更加混乱并且软骨内的蛋白多糖含量降低。胶原纤维的分解导致水含量的净增加。这种增加的发生是因为虽然蛋白多糖总体损失（因此渗透性降低），但胶原蛋白的损失却超过了蛋白聚糖的损失。没有蛋白多糖的保护作用，软骨的胶原纤维会变得易于降解。从而加剧了退化。滑膜（关节腔衬里）和周围关节囊的炎症也可发生，但通常是轻微的（与类风湿性关节炎中发生的滑膜炎症相比）。这可能发生，因为来自软骨的分解产物被释放到滑膜空间中，并且关节内衬的细胞试图将它们移除。

关节内的其他结构也会受到影响。关节内的韧带变厚并纤维化，半月板可能受损并磨损。当一个人进行关节置换时，半月板可以完全缺席。新的骨生长物，称为“骨刺”或骨赘，可以在关节的边缘形成，可能是为了在没有半月板的情况下改善关节软骨表面的一致性。软骨下骨体积增加并且变得较少矿化（低矿化）。所有这些变化都可能导致问题。骨关节炎关节疼痛与增厚的滑膜和软骨下骨病变有关。

诊断
根据病史和临床检查，合理确定诊断。 X射线可以确认诊断。在X射线上看到的典型变化包括：关节间隙变窄，软骨下硬化（关节周围骨形成增加），软骨下囊肿形成和骨赘。平片可能与身体检查的结果或疼痛程度无关。通常，其他成像技术对于临床诊断骨关节炎不是必需的。

1990年，美国风湿病学会使用来自多中心研究的数据，基于硬组织肿大和某些关节肿胀，制定了一套诊断手部骨关节炎的标准。发现这些标准对于手部骨关节炎具有92％的敏感性和98％的特异性，而与类风湿性关节炎和脊柱关节病等其他实体相比。

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严重的骨关节炎和腕关节骨折和第一腕掌关节。

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膝关节骨性关节炎的MRI，关节间隙的特征性变窄。

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左膝原发性骨关节炎。注意骨赘，关节间隙变窄（箭头）和软骨下骨密度增加（箭头）。

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母猪受损的软骨。（a）软骨侵蚀（b）软骨溃疡（c）软骨修复（d）骨赘（骨刺）形成。

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老年女性膝关节骨关节病的组织病理学。

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老年女性膝关节骨关节病的组织病理学。

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在健康的关节中，骨骼的末端被包裹在光滑的软骨中。它们共同受到一个内衬滑膜的关节囊的保护，滑膜产生滑液。胶囊和液体保护软骨，肌肉和结缔组织。

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对于骨关节炎，软骨会磨损。骨刺从骨骼边缘长出，滑液增加。总而言之，关节感觉僵硬和疼痛。

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骨性关节炎

分类

许多分类系统用于骨关节炎的分级：

WOMAC量表，考虑到疼痛，僵硬和功能限制。
Kellgren-Lawrence膝关节骨性关节炎评分量表。它仅使用投影射线照相功能。
Tönnis对髋关节骨关节炎的分类，也仅使用投影射线照相功能。
膝关节损伤和骨关节炎结果评分（KOOS）和髋关节残疾和骨关节炎结果评分（HOOS）调查。
根据是否存在可识别的潜在原因，骨关节炎可分为原发性或继发性。

原发性全身性结节性骨关节炎和糜烂性骨关节炎（EOA，也称为炎性骨关节炎）都是原发性骨关节炎的亚组。 EOA是一种不太常见且更具侵袭性的骨关节炎炎症形式，其经常影响手的远端指间关节并且在X射线上具有特征性的关节侵蚀性变化。

骨关节炎可按受影响的关节分类：

手：
腕掌关节骨关节炎
手腕（腕关节骨性关节炎）
脊柱（脊椎病）
小关节关节病
髋骨关节炎
膝关节骨性关节炎

鉴别诊断
其名称可能与骨关节炎相混淆的相关病症包括假关节病。这源于希腊词根pseudo-，意为“假”，arthr-，意为“联合”，以及用于障碍的终止症。射线照相诊断可以诊断关节内的骨折，这不能与骨关节炎相混淆，骨关节炎是影响女性患者远端指骨关节高发的退行性病变。在受影响的关节的骨骼上也可能出现抛光的象牙状外观，反映出一种叫做灼烧的变化。

管理
示例强化，有氧调节和运动范围练习的插图

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患有骨关节炎的人应该做不同类型的运动，以获得对身体不同的益处。
改变生活方式（如减肥和运动）和镇痛药是主要的治疗方法。对乙酰氨基酚是推荐的第一线，NSAIDs仅在疼痛缓解不足时用作治疗添加剂。这是由于对乙酰氨基酚的安全性相对较高。

改变生活方式
对于超重的人来说，减肥可能是一个重要因素。患者教育已被证明有助于关节炎的自我管理。它可以减轻疼痛，改善功能，减少僵硬和疲劳，并减少医疗用量。与髋关节骨性关节炎患者单独使用NSAID相比，患者教育可以使疼痛平均减轻20％。

物理措施
对膝关节和髋关节骨性关节炎患者的疼痛和功能进行适度运动可能是有益的。这些练习应该每周至少进行三次。虽然一些证据支持某些物理疗法，但合并计划的证据有限。提供明确的建议，使练习愉快，并向人们保证锻炼的重要性可以带来更大的好处和更多的参与。没有足够的证据来确定按摩疗法的有效性。手动治疗的证据尚无定论。已建议进行功能，步态和平衡训练，以解决下肢关节炎患者的位置感，平衡和力量损伤，因为这些可能导致老年人跌倒率更高。对于患有手部骨关节炎的人来说，锻炼可以为改善手部功能，减轻疼痛和缓解手指关节僵硬提供小的益处。

外侧楔形鞋垫和中性鞋垫似乎不适用于膝关节骨性关节炎。膝盖支撑可能会有所帮助，但它们的用处也存在争议。对于疼痛管理，热量可用于缓解僵硬，冷敷可缓解肌肉痉挛和疼痛。在髋关节和膝关节骨性关节炎患者中，水中运动可以减少疼痛和残疾，并在短期内提高生活质量。此外，有氧运动和步行等治疗性运动项目可在膝关节骨性关节炎患者项目结束后长达6个月内减轻疼痛并改善身体机能。

药物治疗

止痛药对乙酰氨基酚是骨关节炎的第一线治疗药物。然而，2015年的一项审查发现，对乙酰氨基酚仅具有短期效益。对于轻度至中度症状，对乙酰氨基酚的有效性类似于非甾体抗炎药（NSAID），如萘普生，但对于更严重的症状，NSAID可能更有效。 NSAID与更大的副作用相关，例如胃肠道出血。双氯芬酸可能是最有效的NSAID。

与非选择性NSAID相比，另一类NSAIDs，COX-2选择性抑制剂（如塞来昔布）同样有效，并且具有较低的不良胃肠道反应率，但心肌梗塞的心血管疾病发生率较高。它们也比非特异性NSAID更昂贵。个人的利益和风险各不相同，在做出治疗决策时需要考虑，需要进行比较NSAIDS和COX-2选择性抑制剂的进一步无偏见的研究。局部应用的NSAIDS对少数人有效。 COX-2选择性抑制剂罗非昔布于2004年从市场上移除，因为心血管事件与长期使用有关。

2周后未能在骨关节炎中达到理想的疼痛缓解，应引发剂量和止痛药的重新评估。口服阿片类药物，包括曲马多等弱阿片类药物和强效阿片类药物，也经常开处方。它们的适用性是不确定的，并且通常仅在一线治疗失败或禁忌时推荐使用阿片类药物。这是由于它们的小益处和相对大的副作用风险。口服类固醇不推荐用于治疗骨关节炎。

口服抗生素多西环素治疗骨关节炎与功能或关节疼痛的临床改善无关。与强力霉素治疗可能解决关节间隙变窄有关的任何微小益处尚不清楚，并且副作用的潜在危害抵消了任何益处。

局部
有几种NSAID可供局部使用，包括双氯芬酸。从2016年开始的Cochrane评价得出结论，合理可靠的证据仅适用于40岁以上患有疼痛性膝关节炎的人使用局部双氯芬酸和酮洛芬。通常不推荐透皮阿片类止痛药治疗骨关节炎。使用局部辣椒素治疗骨关节炎是有争议的，因为有些评论发现有益，而有些则没有。

联合注射
联合注射糖皮质激素（如氢化可的松）可导致短期疼痛缓解，可持续数周至数月。与用于膝关节炎的安慰剂相比，注射透明质酸没有产生改善，但确实增加了进一步疼痛的风险。在踝关节骨关节炎中，证据尚不清楚。注射富含血小板的血浆的有效性尚不清楚;有人建议这种注射可以改善功能而不是疼痛，并且与风险增加有关。

2015年Cochrane评价发现膝关节内注射皮质类固醇不利于生活质量，对膝关节间隙没有影响;由于研究质量差，无法明确确定注射后一至六周的临床效果。另一项2015年的研究报告了较高剂量的关节内皮质类固醇注射的负面影响，2017年的一项试验显示，与安慰剂相比，每12周一次关节内曲安奈德软骨厚度减少2年。 2018年的一项研究发现，关节内曲安奈德与眼压升高有关。

手术
如果骨关节炎症状对生活质量的影响是显着的并且更保守的管理是无效的，则可以推荐关节置换手术或表面重修。证据支持膝关节和臀部的关节置换，因为它既具有临床疗效又具有成本效益。将关节软骨从非承重区域转移到受损区域的手术是一种可能成功的手术，但是转移的软骨与转移部位的现有软骨很好地整合存在问题。

截骨术可能对膝关节骨性关节炎患者有用，但尚未得到很好的研究，目前尚不清楚它是否比非手术治疗或其他类型的手术更有效。关节镜手术在很大程度上不推荐，因为它不能改善膝关节骨关节炎的预后，并可能导致伤害。

对于患有肩关节骨关节炎并且对药物治疗方法无反应的人，手术选择包括肩关节半髋成形术（替换关节的一部分）和全肩关节成形术（替换关节）。

替代药物
氨基葡萄糖和软骨素
葡萄糖胺的有效性是有争议的。评论发现它等于或略好于安慰剂。硫酸葡萄糖胺和盐酸氨基葡萄糖之间可能存在差异，硫酸葡萄糖胺显示有益，而盐酸氨基葡萄糖则没有。氨基葡萄糖硫酸盐对骨关节炎进展有影响的证据有些不清楚，如果存在可能适度。国际骨关节炎研究协会建议，如果在六个月后没有观察到效果，则停用氨基葡萄糖，并且国家健康和护理卓越研究所不再推荐使用。尽管难以确定葡萄糖胺的功效，但它仍然是一种可行的治疗选择。欧洲骨质疏松症和骨关节炎临床和经济学会（ESCEO）推荐硫酸氨基葡萄糖和硫酸软骨素治疗膝关节骨性关节炎。它作为骨关节炎的治疗方法通常是安全的。

2015年Cochrane对软骨素临床试验的回顾发现，大多数质量较低，但有一些证据表明疼痛可以短期改善，副作用很少;它似乎没有改善或维持受影响关节的健康。

其他补救措施
鳄梨 - 大豆不皂化物（ASU）是一种由鳄梨油和大豆油制成的提取物，在全球以许多品牌销售，作为膳食补充剂和法国的药物。 2014年Cochrane评价发现虽然ASU可能有助于缓解一些骨关节炎患者的短期疼痛，但似乎并未改善或维持受影响关节的健康。该评价指出，一项高质量的两年临床试验将ASU与软骨素进行了比较，后者对骨关节炎的疗效不确定;研究发现两者没有区别。审查还发现，尽管ASU似乎是安全的，但尚未对其安全性进行充分研究。

魔鬼爪，姜黄素，植物色素，SKI306X和s-腺苷甲硫氨酸（SAMe）可能有效改善疼痛。有试验证据支持猫爪，透明质酸，甲磺酰甲烷（MSM）和玫瑰果。一些关于乳香锯缘青蟹的高质量研究表明疼痛和功能的改善是一致的，但很小。

几乎没有证据支持某些补品的益处，包括：阿育吠陀草药制剂，品牌名为Articulin F和Eazmov; Duhuo Jisheng Wan，一种中草药制剂;鱼肝油;生姜;草药制剂gitadyl; ω-3脂肪酸;名牌产品Reumalax;荨麻维生素A，C和E的组合;单独维生素E;维生素K;维生素D;胶原;和柳树皮。没有足够的证据来建议这些治疗的安全性和有效性。

不建议常规使用膳食补充剂s-腺苷甲硫氨酸，因为没有进行足够的高质量试验来评估其效果。

针灸和其他干预措施
虽然针灸可以改善疼痛缓解，但这种改善很小，可能具有可疑的重要性。外周关节骨关节炎的等候名单对照试验确实显示出临床相关的益处，但这些可能是由于安慰剂效应。针灸似乎不会产生长期效益。

虽然电刺激技术如TENS已经使用了20年来治疗膝关节骨性关节炎，但没有确凿的证据表明它能减轻疼痛或残疾。 Cochrane对低强度激光治疗的综述发现了不明确的有益效果，而另一项综述发现骨关节炎膝关节可以短期缓解疼痛。

需要进一步研究以确定骨关节炎（矿物浴或水疗）的浴疗法是否能改善人的生活质量或功能。冰或冷包的使用可能是有益的，但是需要进一步的研究。没有证据表明将热敷袋放在关节上会有好处。

低质量证据表明治疗性超声可能对膝关节骨性关节炎患者有益，但需要进一步研究以确认和确定这种潜在益处的程度和重要性。

有弱证据表明电磁场治疗可能导致中度疼痛缓解，但是需要进一步研究，并且不知道电磁场治疗是否可以改善生活质量或功能。

流行病学
2004年全球骨关节炎热图 - 按国家调整生命年

[attach]5121[/attach]
2004年每10万居民中骨关节炎的残疾调整生命年。

从全球来看，截至2010年，约有2.5亿人患有膝关节骨性关节炎（占总人口的3.6％）。髋骨关节炎影响约0.85％的人口。

截至2004年，全球骨关节炎导致4340万人中度至重度残疾。在所评估的291种疾病状况中，膝关节和髋关节骨关节炎在全球范围内排在第11位。

美国
截至2012年，骨关节炎影响美国5250万人，其中约50％为65岁或以上。据估计，到65岁时，80％的人口都有骨关节炎的影像学证据，尽管只有60％的人会出现症状。到2040年，预计美国的骨关节炎发病率将达到7800万（26％）。

在美国，2011年大约有964,000例骨关节炎住院治疗，每10,000人中有31人住院。这笔费用总额为148亿美元（每次入住15,400美元），是2011年美国医院住院费用的第二大成本。通过付款人，这是医疗保险和私人保险的第二大成本条件。

历史
化石记录中发现的骨关节炎的证据由古代病理学家，古代疾病和损伤专家研究。据报道，大型食肉恐龙异龙（Allosaurus fragilis）的化石中存在骨关节炎。

根据对骨骼的研究，自20世纪中期以来，人类膝关节骨性关节炎可能翻了一番。

词源
骨关节炎来自前骨 - （来自古希腊语：ὀστέον，translit.ostéon，lit。'骨'）与关节炎（来自ἀρθρῖτῐς，arthrîtis，lit。'或关节'），它本身来源于arthr-（来自ἄρθρον，árthron，lit。'joint，limb'）和-itis（来自-ῖτις，-îtis，lit。'属于'），后一种后缀已经与炎症有关。骨关节炎的炎症可能被认为是误导性的，因为炎症不是一个显著的特征。一些临床医生将这种情况称为骨关节病，表示缺乏炎症反应，后缀发生（来自-ωσις，-ōsis，lit。'（异常）状态，状况或行为'）简单地指病理本身。

研究
目前正在努力确定是否存在改变骨关节炎结果的药剂。 Sprifermin是一种候选药物。还有初步证据表明雷奈酸锶可以减少骨关节炎的退化并改善预后。

除了试图寻找用于骨关节炎的疾病调节剂之外，还有新的证据表明，基于系统的方法对于找到骨关节炎的原因是必要的。由于生物力学，生物学或关节结构的异常导致他们发展临床疾病，临床疾病明显之前可能会发生变化。因此，研究重点是使用骨关节炎风险的生物学，机械学和成像标志物来定义这些早期骨关节炎前的变化，强调多学科方法，并研究能够在疾病变得明显之前逆转健康关节中的骨关节炎风险的个性化干预。

基因转移策略旨在针对疾病过程而不是症状。

正在研究细胞介导的基因治疗。韩国批准了一种用于治疗中度膝关节骨性关节炎的病例。截至2017年，它在美国尚未获得批准，并在美国开发。该药物是关节内给药的。

生物标志物
2015年公布了关于在骨关节炎临床试验中纳入可溶性生物标志物的要求的指南，但截至2015年，尚未确认骨关节炎的生物标志物。 2015年对骨关节炎生物标志物进行系统评价，寻找可用于风险评估的分子，在25篇出版物中发现了37种不同的骨和软骨转换生化标志物。最有力的证据是II型胶原的尿C末端端肽（uCTX-II）作为膝关节骨性关节炎进展的预后标志物和血清软骨寡聚基质蛋白（COMP）水平作为膝关节和髋关节骨关节炎发病率的预后标志物。对髋关节骨关节炎中生物标志物的综述也发现与uCTX-II有关。前胶原II型C-末端前肽（PIICP）水平反映体内II型胶原合成，并且在关节液内PIICP水平可用作早期骨关节炎的预后标志物。

使用来自关节软骨破坏的特定II型胶原生物标记物的一个问题是随着时间的推移软骨的量随着疾病的进展而减少（磨损）。结果，患者最终可能患有非常晚期的骨关节炎，其尿液中没有可检测到这种生物标志物。全身生物标志物的另一个问题是患者可能同时在疾病的不同阶段的多个关节中患有骨关节炎，因此不能确定生物标志物来源。滑膜液中的一些其他胶原蛋白分解产物在急性损伤（已知的继发性骨关节炎的原因）后相互关联，但与损伤的严重程度无关。

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