Serum intestinal permeability biomarkers are associated with erosive hand osteoarthritis and radiographic severity: results from the DIGICOD cohort

Abstract

Objective: To investigate the association between intestinal permeability alteration and erosive hand osteoarthritis (EHOA). Methods: Serum concentrations of four intestinal permeability biomarkers (lipopolysaccharide binding protein (LBP), FABP2, sCD14, Zonulin-related proteins (ZRP) along with calprotectin, and high-sensitivity CReactive Protein (hs-CRP) were assessed in 410 patients of the DIGICOD cohort. The study compared patients with EHOA (>= 2 erosion in Verbruggen score N=140) to those without EHOA (N=270) using the MannWhitney U test. Logistic regression was performed to adjust for potential covariates. The Spearman rank test was used to investigate the correlation between intestinal permeability biomarkers and seven clinical variables associated with HOA clinical and radiographic severity. Results: Serum levels of LBP and ZRP were found to be higher in patients with EHOA compared to those without EHOA (p=0.001, p=0.04). Additionally, LBP and ZRP remained associated with EHOA in a logistic regression model adjusted for age, body mass index, and sex (p=0.017, p=0.0 05). ZRP was positively correlated with Verbruggen score and Kellgren-Lawrence sum score of both hands (r=0.14 p=0.0 05, r=0.12 p=0.023). LBP was positively correlated with the number of erosive joints (r=0.14 p=0.00 06). Hs-CRP and LBP were positively correlated with AUSCAN pain (r=0.14 p=0.0 08, r=0.10 p=0.042). Conclusions: LBP and ZRP were associated with EHOA with clinical and radiographic severity in HOA. These results overall support the role of intestinal permeability in both symptoms and structural alteration in HOA. (c) 2025 The Author(s). Published by Elsevier Ltd on behalf of Osteoarthritis Research Society International. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).