Serum Cartilage Oligomeric Matrix Protein (COMP) Estimation: A Tool to Assess Efficacy of Treatment in Knee Osteoarthritis

Abstract

Context: Osteoarthritis is a leading cause of disability in older adults. Various treatment options present, ranging from lifestyle modification to total knee replacement. What is the effect of on-going treatment over disease and at what stage the patient requires change of therapy is the questions which still need to be answered. Developing an investigatory modality to provide information about efficacy of on-going treatment is the need of the hour. Aim: Aim of present study is to estimate and compare serum levels of Cartilage Oligomeric Matrix Protein (COMP) for assessing efficacy of treatment and disease prognosis in patients having knee osteoarthritis. Settings and design: It is a prospective randomized control trial which was conducted in the Department of orthopedics, in a tertiary care teaching hospital in Northern India within a period of two year recruiting 100 cases. Methods and materials: All the cases were asked to fill the WOMAC questionnaire and Kellgren Lawrence (KL) Grading was done for all. The serum level of COMP was estimated by ELISA. The value of serum COMP was compared with WOMAC score and KL grading scale. The cases were prescribed medications according to standard management guidelines of OARSI. Follow up was done after every four weeks to assess the efficacy of treatment and disease progression. Results: The level of increase in Serum COMP corresponds to the severity of disease, and radiological staging. In almost all treatment groups Serum COMP level exhibited a downward trend which is gradually regressive with increasing time and continued therapy. In mild cases, the patients treated with Diacerin and lifestyle modification showed best results clinically and in lab values. In moderate cases, the patients treated with Diacerin, Glucosamine with MSM and lifestyle modification showed best results clinically and in lab values. In severe cases, patients treated with Diacerin, Glucosamine with MSM showed best results clinically and in lab values. Conclusion: Serum COMP levels can be used as a prognostic and therapeutic indicator of knee osteoarthritis. The Serum COMP levels give a quantitative explanation about the effectiveness of ongoing treatment. In both mild and moderate knee osteoarthritis, combination of lifestyle modification with pharmacotherapy is superior over pharmacotherapy alone. In severe cases serum COMP values show least improvement, which indicates about limited control of pharmacological therapy in these patients.