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Is there an association between pseudoexfoliation syndrome and knee osteoarthritis?

Besteht ein Zusammenhang zwischen Pseudoexfoliationssyndrom und Kniegelenksarthrose?

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Abstract

Aim

The purpose of this study was to investigate whether there is an association between pseudoexfoliation (PEX) syndrome and knee osteoarthritis (OA), and compare to compare patients with PEX and OA to a control group without PEX.

Design and methods

This observational case–control study examined 254 subjects: 127 cases with PEX in at least one eye and 127 controls without PEX. A full ophthalmic examination including slit lamp biomicroscopy, gonioscopy, applanation tonometry, pupil dilation, and fundus examination was performed for the diagnosis of PEX. Knee pain was evaluated using a visual analogue scale (VAS). Knee OA was diagnosed according to American College of Rheumatology (ACR) criteria and graded according to the Kellgren and Lawrence (KL) grading scale on radiographic examination.

Results

Of the 254 subjects, 171 (67.3 %) had severe OA and 83 (32.7 %) mild OA. Of the 171 patients with severe knee OA, 93 (54.4 %) had ocular PEX and the remaining 78 (45.6 %) had normal ophthalmologic examination results. Both the PEX and the control groups conained 127 patients; the number of patients with moderate–severe OA was significantly (p = 0.032) higher in the PEX group as compared to controls: 93 patients (73.2  %) in the PEX group and 78 (61.5  %) in the control group. VAS score (p = 0.037) and KL grade (p = 0.024) were significantly higher in the PEX group than in controls. As evidenced by the odds ratios (ORs) pertaining to the severity of OA, age (OR = 1.112; 95 % confidence interval, CI: 1.054–1.173) and PEX (OR = 2.044; 95 % CI: 1.164–3.584) had a significant influence, but gender did not.

Conclusion

This study suggests a probable relationship between OA and ocular PEX. Further studies are needed to analyze the molecular basis of this association. Patients with severe knee OA should be informed about the possibility of having PEX and may be referred for ophthalmologic examination.

Zusammenfassung

Zielsetzung

In dieser Studie wurde untersucht, ob ein Zusammenhang zwischen dem Pseudoexfoliations(PEX)-Syndrom und der Kniegelenksarthrose besteht. Patienten mit PEX und Arthrose wurden mit einer Kontrollgruppe ohne PEX verglichen.

Design und Methodik

In diese Fall-Kontroll-Studie mit Beobachtungsdesign wurden 254 Patienten eingeschlossen: 127 Fälle mit PEX-Syndrom in mindestens einem Auge und 127 Kontrollpersonen ohne PEX-Syndrom. Zur Diagnose des PEX-Syndroms wurde eine umfassende Augenuntersuchung durchgeführt, die eine Spaltlampenbiomikroskopie, Gonioskopie, Applanationstonometrie sowie die Überprüfung der Pupillenerweiterung und des Augenhintergrunds beinhaltete. Der Knieschmerz wurde mit einer visuellen Analogskala (VAS) ermittelt. Die Diagnose der Kniegelenksarthrose richtete sich nach den Kriterien des American College of Rheumatology (ACR). Der Schweregrad der Erkrankung wurde anhand der Kellgren-Lawrence-Skala zur radiologischen Klassifikation ermittelt.

Ergebnisse

Eine schwere Kniegelenksarthrose hatten 171 (67,3 %) der 254 Teilnehmer, eine milde Arthrose 83 (32,7 %). Von den 171 Patienten mit schwerer Arthrose hatten 93 (54,4 %) ein PEX-Syndrom, bei den übrigen 78 (45,6 %) blieb die ophthalmologische Untersuchung ohne Befund. Sowohl die PEX- als auch die Kontrollgruppe umfasste 127 Patienten. Die Zahl der Patienten mit mäßiger bis schwerer Kniegelenksarthrose war in der PEX-Gruppe signifikant höher als in der Kontrollgruppe [93 (73,2 %) vs. 78 (61,5 %); p = 0,032]. Der VAS-Score (p = 0,037) und Schweregrad auf der Kellgren-Lawrence-Skala (p = 0,024) waren in der PEX-Gruppe signifikant höher als in der Kontrollgruppe. Wie die Odds Ratios (OR) bezüglich des Schweregrads der Arthrose zeigen, hatten das Alter (OR = 1,112; 95 %-Konfidenzintervall: 1,054–1,173) und PEX-Syndrom (OR = 2,044; 95 %-Konfidenzintervall: 1,164–3,584) einen signifikanten Einfluss, nicht aber das Geschlecht.

Schlussfolgerung

Nach den Ergebnissen dieser Studie ist ein Zusammenhang zwischen Arthrose und PEX-Syndrom wahrscheinlich. In kommenden Studien müssen die molekularen Grundlagen dieser Beziehung untersucht werden. Patienten mit schwerer Kniegelenksarthrose sollten darüber informiert werden, dass bei ihnen möglicherweise ein PEX-Syndrom vorliegt. Eine augenärztliche Untersuchung ist sinnvoll.

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Authors’ contributions

M.U. developed the original idea, designed and managed the study, drafted the manuscript, planned the analysis, and extracted and analyzed data. U.S., H.O.A., K.K., F.G., and M.U. designed and managed the study, planned the analysis, and extracted and analyzed data. K.K., F.G., M.A., and M.U. designed and managed the study, extracted data, and edited the manuscript. U.S., K.K, H.O.A., M.A., and F.G. designed the study, extracted data, and edited the manuscript. All authors approved the final version.

Compliance with ethical guidelines

Conflict of interest. M. Ucar, U. Sarp, K. Kirboga, M. Adam, H.O. Arik, and F. Gundogdu state that there are no conflicts of interest. All studies on humans described in the present manuscript were carried out with the approval of the responsible ethics committee and in accordance with national law and the Helsinki Declaration of 1975 (in its current, revised form). Informed consent was obtained from all patients included in studies. Consent was obtained from all patients identifiable from images or other information within the manuscript. In the case of underage patients, consent was obtained from a parent or legal guardian

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Authors and Affiliations

  1. Department of Physical Medicine and Rehabilitation, Bozok University School of Medicine, 66001, Yozgat, Turkey

    M. Ucar MD

  2. Department of Physical Medicine and Rehabilitation, Yozgat State Hospital, Yozgat, Turkey

    U. Sarp

  3. Department of Ophthalmology, Yozgat State Hospital, Yozgat, Turkey

    K. Kirboga

  4. Department of Ophthalmology, Bozok University School of Medicine, Yozgat, Turkey

    M. Adam

  5. Department of Orthopaedics and Traumatology, Yozgat State Hospital, Yozgat, Turkey

    H.O. Arik

  6. Department of Radiology, Yozgat State Hospital, Yozgat, Turkey

    F. Gundogdu

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  1. M. Ucar MD
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Correspondence to M. Ucar MD.

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Ucar, M., Sarp, U., Kirboga, K. et al. Is there an association between pseudoexfoliation syndrome and knee osteoarthritis?. Z Rheumatol 74, 819–823 (2015). https://doi.org/10.1007/s00393-015-1575-4

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  • DOI: https://doi.org/10.1007/s00393-015-1575-4

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