الفهرس 
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Abstract
Osteoarthritis (OA) is one of the most prevalent joint diseases that is expected to become more common with aging and overweight populations. Inflammation of the synovium, destruction of the extracellular matrix, articular cartilage degradation, and remodeling of the subchondral bone tissue are characteristics of OA (Mabey et al., 2014).
Extracellular matrix proteins such as osteopontine (OPN) was found to play important roles in promoting the inflammatory occurrence of car¬tilage cells in knee osteoarthritis, As an important extracellular matrix protein, OPN can mediate cellular growth, survival, adhesion and migration in osteoarthritis (Hasegawa et al., 2011 and Qin et al., 2013).
This study aimed to evaluate the role of osteopontine levels in plasma and synovial fluid in diagnosis and prognosis of patients with primary knee osteoarthritis and its relation to MRI.
The study was included 60 patients with primary knee OA and 60 apparently healthy individuals served as control for plasma osteopntine. The OA patients subjected to evaluation of pain by patient pain VAS and functional status by WOMAC score. Radiological assessment by anteroposterior view for the affected knee and evaluation of disease severity by Kellgren-Lawrence grading system, ESR, CRP also done as inflammatory markers, plasma and synovial fluid osteopontine levels was detected also. MRI study of the knee by1.5 tesla Philips closed MR scanner. Semi-quantitative whole joint assessment of the knee was done using
MOAKS scoring system, which assessed articular cartilage loss score and BMLs score.
Plasma OPN level was significantly higher in OA patients than control, while synovial fluid OPN level was higher than plasma levels in OA patients.
Positive correlation found between synovial fluid and plasma OPN and radiographic severity by Kellgren-Lawrence (KL) score, synovial and plasma OPN level was significantly higher in patients with KL grade 4 than with KL grade 2 and 3.
There was statistically significant correlation between plasma and synovial OPN levels with functional ability score by WOMAC.
A statistically significant correlation was found between plasma and synovial fluid OPN with cartilage loss score and BMLs score done by MRI with significant specificity and sensitivity.
from the result of our study we can conclude that:
• OPN is increased locally in synovial fluid due to in situ production within the knee joint; it may be useful for monitoring OA severity.
• OPN levels in both plasma and synovial fluid were positively correlated with the radiographic grading and severity of knee OA. Therefore, OPN could play a substantial role in the development and progression of knee OA.
• OPN has significant correlation with function status and chronicity of OA knee assessed by MOAKS score done by MRI with significant sensitivity and specificity, so OPN can be used as diagnostic and prognostic test in evaluation of knee OA as an easier and specific marker.
• Since OPN could be a potential candidate of biochemical markers for the assessment of OA severity. It could be useful in diagnosis of advanced and severe osteoarthritis and in prediction for progression of the disease.
• OPN contributes to the pathogenesis of osteoarthritis and it could be a potential therapeutic target of osteoarthritis.
Recommendations:
1- Large sample size should be studied.
2- Other joints could be included.
3- Using other more sensitive inflammatory markers to be compared with MRI.
4- Using other methods for osteopontine detection to confirm the results.