Differential expression and correlation of inflammatory markers and bone metabolism markers in osteoarthritis, gouty arthritis and rheumatoid arthritis:a retrospective cohort study

Differential expression and correlation of inflammatory markers and bone metabolism markers in osteoarthritis, gouty arthritis and rheumatoid arthritis:a retrospective cohort study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Differential expression and correlation of inflammatory markers and bone metabolism markers in osteoarthritis, gouty arthritis and rheumatoid arthritis:a retrospective cohort study Yongting Liu, Shanshan Liu, Jianhui Ma, Yi Ling, Xue Wu, Zhengqi Liu This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7193571/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objectives To investigate the differences in the expression of inflammatory and bone metabolism markers in patients with osteoarthritis, gouty arthritis and rheumatoid arthritis, and to elucidate the correlation between the markers of the three diseases. Methods 373 patients were retrospectively analyzed, including 138 patients with osteoarthritis(OA), 72 patients with gouty arthritis(GA) and 163 patients with rheumatoid arthritis༈RA༉. Blood indices included inflammatory indices and bone metabolism indices. In this study, we firstly screened the three kinds of differential markers by differential analysis between diseases, secondly used correlation analysis to determine the correlation between markers, and finally performed binary logistic regression analysis. Results fibrinogen(FIB) can be used as an important marker to differentiate OA, GA and RA.The level of FIB was higher in GA, slightly lower in RA than in GA, and lower in OA, and there was a positive correlation between FIB and erythrocyte sedimentation rate(ESR).The area under the curve(AUC) of FIB in OA and GA patients was 0.87 (95% CI: 0.82, 0.92), the AUC value of ESR/Ca in OA and RA was 0.79 (95% CI: 0.74, 0.84), and the AUC value of the combination of disease indexes was 0.84 (95% CI: 0.79, 0.88).The AUC value of FIB in GA and RA and the FIB/ PLT had an AUC value of 0.66 (95% CI: 0.59, 0.74) and disease marker combination AUC value of 0.73 (95% CI: 0.66, 0.81). Conclusions FIB was positively correlated with c-reactive protein(CRP),ESR, and platelet(PLT) in OA, GA, and RA patients, and FIB, P/FIB ratio, and FIB/Ca ratio were significantly different in OA, GA, and RA patients. PLT, ESR/CA, FIB/CA, PTH, FIB, FIB/PLT marker combinations may also be used to differentiate OA, GA, and RA patients. osteoarthritis gouty arthritis rheumatoid arthritis inflammatory markers bone metabolism markers Figures Figure 1 Introduction Common bone and joint diseases in rheumatology include OA, GA, RA,etc. OA is the most common chronic degenerative disease of the bone and joints in clinical practice [1,2] , characterized by Degeneration of articular cartilage as well as changes in subchondral bone, synovium and surrounding joint tissues, with clinical manifestations of persistent joint pain, tenderness, bone friction sounds, joint deformity and dysfunction, which seriously affects the quality of life of patients [ 3 ] .GA is associated with disturbances in purine metabolism and/or impaired excretion of uric acid, and it is a crystalline arthropathy in which single-sodium urates are deposited in the joints, and the clinical manifestations can be seen as affected joints often presenting with varying degrees of pain, Clinical manifestations show that the affected joints often have different degrees of pain, pressure and swelling, and some of the soft tissues around the joints can be seen as gout stone deposits [ 4 , 5 ] . In addition, RA is a chronic, systemic autoimmune disease [ 6 ] , is mainly characterized by erosive and symmetric synovitis and multi-system involvement, and can accumulate multiple organ systems such as the eye, heart, brain, kidney, etc. [ 7 ] , whose basic pathological changes are synovitis leading to synovial abnormal proliferation, destruction of cartilage, bone, and joint capsule of affected joints, and the clinical manifestations of joint pain with swelling, The clinical manifestations are joint pain with swelling, stiffness and induration [8] , and in advanced stages, it can lead to joint deformity and loss of joint movement function. In summary, all three diseases can cause bone and joint destruction and deformity. OA, GA, and RA belong to the same joint diseases, the etiology and pathogenesis of the three are different and complex, but the clinical manifestations are similar, there are different degrees of osteoarticular pain and bone destruction, missed diagnosis, misdiagnosis of cases have been reported, gouty arthritis is easy to misdiagnose rheumatoid arthritis, osteoarthritis is also often misdiagnosed as rheumatoid arthritis, in addition, the same patient may be suffering from two or three diseases at the same time, for example, patients with gouty arthritis are combined with rheumatoid arthritis. Gouty arthritis patients with rheumatoid arthritis. It was found [ 9 ] that among 22 hospitalized patients initially diagnosed with rheumatoid arthritis, 12 cases were misdiagnosed as OA, 5 cases as rheumatoid RA, 4 cases as GA, and 1 case as septic arthritis in the later stage of the follow-up, so it is of great significance for the diagnosis of the disease, patient treatment, and prognosis to screen out disease-specific indexes and to reduce the disease misdiagnosis and underdiagnosis. At present, the early diagnosis of OA, GA, and RA is based on relevant laboratory markers and imaging tests, and patients in some areas rely only on imaging tests; however, imaging tests have a relative lag, and the appearance of imaging joint destruction is already at an advanced stage, resulting in irreversible joint deformity and joint dysfunction in patients. Clinically, patients already have abnormal laboratory markers in the early stage of the disease, and some studies have found [ 10 ] that CRP levels are significantly higher in rheumatoid arthritis patients than in gouty arthritis. Currently, there are fewer studies on the screening of markers distinguishing these three diseases by inflammatory markers and bone metabolism markers, and their correlation still needs to be investigated. Therefore, retrospective analysis of inflammatory markers and bone metabolism markers in patients with OA, GA, and RA, clarifying the correlation of inflammatory markers and bone metabolism markers among the three, and establishing a model for the differentiation of the three diseases of OA, GA, and RA, will provide support for earlier and more accurate diagnosis of the diseases, and will be of great clinical significance for the progression of patients' conditions and prevention. 1 Materials and Methods 1.1 Clinical data A total of 373 hospitalized patients from the Department of Rheumatology and Immunology at the Second Affiliated Hospital of Guizhou University of Traditional Chinese Medicine between June 2016 and February 2020 were selected as research subjects. The OA group consisted of 138 cases, with 22 males and 116 females, and an average age of (69.90 ± 12.10) years. The GA group had 72 cases, with 70 males and 2 females, and an average age of (60.72 ± 12.03) years; the RA group included 163 cases, with 59 males and 104 females, and an average age of (62.09 ± 10.18) years. There were statistically significant differences in gender and age among the three groups ( P < 0.05 ). The collected inflammatory markers included CRP, ESR, FIB and PLT. Bone metabolism markers included 25-hydroxyvitamin D (25(OH)D), calcium (Ca), phosphorus (P), and parathyroid hormone (PTH). 1.2 Inclusion criteria ① OA was based on the 2009 EULAR diagnostic criteria [ 11 ] , GA was based on the 2015 ACR/EULAR diagnostic criteria for gout [ 12 ] , and RA was based on the 2015 ACR/EULAR diagnostic criteria [ 13 ] .②Age 18 years or older and gender was not limited. 1.3 Exclusion criteria ①those who did not meet the above diagnostic criteria; ②patients with other causes of peripheral arthropathy; ③ those with other critical illnesses; ④ patients with fever, infection, bleeding and surgical treatment; ⑤those with seriously incomplete data. This study was approved by the Ethics Committee of the Second Affiliated Hospital of Guizhou University of Traditional Chinese Medicine (approval number: lw20240718). 1.4 Statistical methods SPSS26.0 software was used for statistical analysis, and the measurements were expressed as( \(\:\stackrel{-}{x}\) ±sd ), and the count data were expressed as n (%), according to the results of the normality test, t-test was used for those with normal distribution; and non-parametric test was used for those with non-normal distribution. Two-by-two comparisons were performed using the Kruskal-wallis test, multifactor correlation analysis was performed using the Pearson test, binary stepwise logistic regression was used to screen the variables, binary logistic regression analysis was used to establish a model distinguishing between OA, GA, and RA, and the area under the curve (AUC) of the ROC curve was used to evaluation and comparison, and the difference was considered statistically significant at P<0.05 . 2 Results 2.1 Basic information statistics of OA, GA, RA patients Comparing the basic information of 373 patients in the clinic, the differences between the three groups of OA, GA, and RA patients in terms of gender, age, height, weight, and bodymass index (BMI) were statistically significant ( P < 0.05 ). And the differences in systolic blood pressure (SBP) (P = 0.265) and diastolic blood pressure (DBP) ( P = 0.569 ) were not statistically significant(Table 1 ). Table 1 Comparison of basic information about OA, GA, and RA diseases( \(\:\stackrel{-}{x}\) ±sd ) OA(n = 138) GA(n = 72) RA(n = 163) P a sex Man Women 22(15.94%) 70(97.22%) 59(36.19%) P <0.001 116(84.05%) 2(2.7%) 104(63.80%) Age 69.90 ± 12.10 60.72 ± 12.03 62.09 ± 10.18 P <0.001 SBP 128.54 ± 14.54 125.49 ± 16.09 127.23 ± 17.51 P = 0.265 DBP 75.81 ± 10.19 75.99 ± 12.22 77.31 ± 10.20 P = 0.569 BMI 23.48 ± 3.16 23.75 ± 3.40 21.98 ± 3.21 P = 0.000 Height 157.41 ± 6.49 164.11 ± 7.08 159.52 ± 7.29 P <0.001 weight 58.28 ± 9.06 64.06 ± 10.46 56.05 ± 9.62 P <0.001 a The significance values have been adjusted using the Bonferroni correction method 2.2 Comparative Analysis of Inflammatory markers in OA, GA, and RA Patients Through the comparison of inflammatory markers among OA, GA, and RA patients, it can be concluded that the differences in the levels of inflammatory markers CRP, ESR, FIB, and PLT among the three groups are statistically significant ( P < 0.05 ); pairwise comparisons between groups found that the levels of CRP, ESR, and FIB in the GA group were higher than those in the OA and RA groups ( P < 0.001 ); the FIB level in the GA group was higher than that in the OA and RA groups ( P < 0.001 ), while the FIB level in the RA group was higher than that in the OA group. The PLT levels in the GA and RA groups were higher than those in the OA group (Table 2 ). Table 2 Comparison of inflammatory markers levels in OA, GA, and RA diseases( \(\:\stackrel{-}{x}\) ±sd ) Inflammatory markers OA GA RA P a CRP 1.45 ± 6.69 7.06 ± 15.34 5.21 ± 13.34 P <0.001 *▲ ESR 20.79 ± 19.7 54.42 ± 35.47 53.25 ± 35.63 P <0.001 *▲ FIB 3.04 ± 1.07 5.36 ± 1.69 4.38 ± 1.62 P <0.001 *▲△ PLT 211.72 ± 68.02 260.31 ± 107.99 283.04 ± 120.29 P <0.001 *▲ * P <0.05:Comparison between the OA group and the RA group ▲ P <0.05:Comparison between the OA group and the GA group; △ P <0.05:Comparison between the RA group and the GA group a The significance values have been adjusted using the Bonferroni correction method 2.3 Comparative Analysis of Bone Metabolism Markers in OA, GA, and RA Patients The results of the inter-group comparison of bone metabolism markers in OA, GA, and RA patients show that the levels of two metabolites, PTH and Ca, are significantly different among the three groups ( P < 0.05 ); pairwise comparisons between groups reveal that the PTH level in the RA group is significantly lower than that in the OA and GA groups ( P < 0.001 ); the Ca level in the RA group is slightly lower than that in the GA group ( P = 0.016 ) (Table 3 ). Table 3 Comparison of bone metabolism markers levels in OA, GA, and RA diseases( \(\:\stackrel{-}{x}\) ±sd ) Bone metabolism markers OA GA RA P a 25-OH-VD 20.60 ± 8.01 22.99 ± 10.82 21.30 ± 9.15 P = 0.355 PTH 58.72 ± 34.07 55.54 ± 31.99 44.14 ± 22.84 P <0.001 *△ P 1.19 ± 0.31 1.17 ± 0.31 1.16 ± 0.25 P = 0.749 Ca 2.38 ± 0.22 2.34 ± 0.18 2.32 ± 0.19 P = 0.016 * P <0.05:Comparison between the OA group and the RA group; △ P <0.05:Comparison between the RA group and the GA group a The significance values have been adjusted using the Bonferroni correction method 2.4 Comparison and analysis of inflammatory indicators and bone metabolism marker ratios in OA, GA, and RA patients. The comparative analysis of inflammatory indicators and bone metabolism marker ratios among the OA, GA, and RA patient groups showed statistically significant differences in the ratios of CRP/25(OH)D, CRP/PTH, CRP/P, CRP/ESR, CRP/FIB, CRP/PLT, CRP/Ca, 25(OH)D/PTH, 25(OH)D/ESR, 25(OH)D/FIB, 25(OH)D/PLT, PTH/P, PTH/ESR, PTH/FIB, PTH/PLT, PTH/Ca, P/ESR, P/FIB, P/PLT, ESR/FIB, ESR/PLT, ESR/Ca, FIB/PLT, FIB/Ca, and PLT/Ca ( P < 0.05 ). Pairwise comparisons of the above ratios revealed that the levels of CRP/25(OH)D, CRP/PTH, CRP/P, CRP/ESR, CRP/FIB, CRP/PLT, CRP/Ca, ESR/FIB, ESR/PLT, ESR/Ca, FIB/Ca, and PLT/Ca in the OA group were lower than those in the GA and RA groups ( P < 0.001 ); the 25(OH)D/PTH ratio in the OA group was lower than that in the RA group; the 25(OH)D/ESR, 25(OH)D/FIB, PTH/ESR, PTH/FIB, PTH/PLT, P/ESR, P/FIB, and P/PLT ratios in the GA and RA groups were all lower than those in the OA group ( P < 0.05 ); the 25(OH)D/PLT ratio in the OA group was higher than that in the RA group (P = 0.012); the PTH/P and PTH/Ca ratio levels in the RA group were lower than those in the OA and GA groups ( P < 0.001 ); the FIB/PLT ratio in the OA and RA groups was lower than that in the GA group ( P < 0.05 ); the P/FIB ratio levels in the OA group were higher than those in the GA and RA groups, with the RA group having a higher P/FIB than the GA group ( P < 0.001 ); the FIB/Ca ratio levels in the GA group were higher than those in the OA and RA groups, while the FIB/Ca level in the RA patients was higher than that in the OA patients ( P < 0.001 ) (Table 4 ). Table 4 Comparison of inflammatory indicators and bone metabolism biomarker ratios in OA, GA, and RA diseases( \(\:\stackrel{-}{x}\) ±sd ) Metabolic indicators OA GA RA P a CRP/25(OH)D 0.08 ± 0.35 0.49 ± 1.28 0.31 ± 0.93 P <0.001 *▲ CRP/PTH 0.03 ± 0.12 0.23 ± 0.78 0.20 ± 0.65 P <0.001 *▲ CRP/P 1.24 ± 5.47 6.11 ± 11.32 4.50 ± 11.10 P <0.001 *▲ CRP/ESR 0.04 ± 0.11 0.15 ± 0.40 0.10 ± 0.20 P <0.001 *▲ CRP/FIB 0.32 ± 1.22 1.19 ± 2.23 1.30 ± 3.73 P <0.001 *▲ CRP/PLT 0.01 ± 0.02 0.03 ± 0.05 0.02 ± 0.04 P <0.001 *▲ CRP/Ca 0.59 ± 2.68 3.03 ± 6.24 2.28 ± 5.76 P <0.001 *▲ 25(OH)D/PTH 0.45 ± 0.31 0.58 ± 0.50 0.61 ± 0.42 P = 0.001 * 25(OH)D/P 18.13 ± 8.19 20.91 ± 10.84 18.98 ± 8.85 P = 0.206 25(OH)D/ESR 1.82 ± 2.93 0.82 ± 0.95 0.92 ± 1.38 P <0.001 *▲ 25(OH)D/FIB 7.30 ± 3.36 4.85 ± 3.19 5.93 ± 6.24 P <0.001 *▲ 25(OH)D/PLT 0.11 ± 0.11 0.13 ± 0.17 0.09 ± 0.06 P = 0.012 * 25(OH)D/Ca 8.72 ± 3.54 9.80 ± 4.53 9.19 ± 3.94 P = 0.267 PTH/P 52.86 ± 34.79 53.01 ± 38.67 41.03 ± 27.62 P <0.001 *△ PTH/ESR 5.57 ± 8.65 2.35 ± 3.60 1.94 ± 2.84 P <0.001 *▲ PTH/FIB 21.35 ± 13.90 12.08 ± 8.99 13.80 ± 24.07 P <0.001 *▲ PTH/PLT 0.31 ± 0.22 0.30 ± 0.30 0.19 ± 0.15 P <0.001 *▲ PTH/Ca 24.78 ± 14.14 23.76 ± 13.73 19.02 ± 9.78 P <0.001 *△ P/ESR 0.10 ± 0.09 0.04 ± 0.05 0.05 ± 0.05 P <0.001 *▲ P/FIB 0.43 ± 0.16 0.25 ± 0.12 0.35 ± 0.61 P <0.001 *▲△ P/PLT 0.01 ± 0.00 0.01 ± 0.01 0.00 ± 0.00 P <0.001 *▲ P/Ca 0.50 ± 0.12 0.50 ± 0.14 0.50 ± 0.11 P = 0.926 ESR/FIB 6.34 ± 3.99 10.06 ± 6.45 15.70 ± 48.13 P <0.001 *▲ ESR/PLT 0.10 ± 0.10 0.24 ± 0.22 0.20 ± 0.14 P <0.001 *▲ ESR/Ca 8.73 ± 8.41 23.86 ± 16.56 23.40 ± 16.28 P <0.001 *▲ FIB/PLT 0.02 ± 0.01 0.03 ± 0.02 0.02 ± 0.01 P <0.001 ▲△ FIB/Ca 1.28 ± 0.46 2.31 ± 0.77 1.91 ± 0.74 P <0.001 * ▲△ PLT/Ca 89.10 ± 28.83 111.76 ± 46.44 123.36 ± 55.75 P <0.001 *▲ * P <0.05:Comparison between the OA group and the RA group ▲ P <0.05:Comparison between the OA group and the GA group; △ P <0.05:Comparison between the RA group and the GA group a The significance values have been adjusted using the Bonferroni correction method 2.5 Correlation analysis of OA, GA, and RA patients Through Pearson correlation analysis, the interrelationships among inflammatory indicators and bone metabolism markers in the three groups of patients (OA, GA, RA) were assessed. From Fig. 1 , it can be seen that in the OA group, CRP is positively correlated with ESR ( P < 0.001 ) and FIB ( P < 0.001 ). ESR is positively correlated with FIB ( P < 0.001 ) and PLT ( P < 0.001 ). FIB is positively correlated with PLT ( P = 0.005 ), and PLT is positively correlated with Ca ( P = 0.022 ). 25(OH)D is negatively correlated with PTH ( P = 0.032 ), and P is positively correlated with Ca ( P = 0.003 ). In the GA group, CRP was positively correlated with ESR ( P = 0.049 ) and FIB ( P = 0.021 ); ESR was positively correlated with FIB ( P < 0.001 ) and PLT ( P = 0.001 ), while it was negatively correlated with PTH and Ca ( P = 0.002 , P < 0.001 ). FIB was positively correlated with PLT ( P = 0.002 ), PLT was negatively correlated with PTH ( P = 0.005 ), and PTH was negatively correlated with P ( P = 0.004 ). In RA patients, CRP is positively correlated with ESR (), FIB ( P = 0.001 ), and PLT ( P = 0.009 ); ESR is positively correlated with FIB ( P < 0.001 ) and PLT ( P < 0.001 ), while negatively correlated with 25(OH)D (P = 0.018), PTH (P = 0.009), and Ca ( P = 0.009 ); FIB is positively correlated with PLT ( P < 0.001 ) and negatively correlated with PTH ( P < 0.001 ); PLT is negatively correlated with 25(OH)D ( P = 0.006 ) and PTH ( P = 0.001 ). 25(OH)D is positively correlated with Ca ( P = 0.041 ); PTH is positively correlated with Ca ( P = 0.026 ) and negatively correlated with P ( P = 0.021 )(Fig. 1 ). 2.6 Logistic regression analysis of inflammatory indicators, bone metabolism indicators, and related ratios in patients with OA, GA, and RA. Table 5 Analysis of Line AUC Values for OA, GA, and RA Patients Markers AUC Confidence lower limit Confidence upper limit ROC comparison test OA-GA P <0.001 ESR 0.81 0.74 0.88 FIB 0.87 0.82 0.92 ESR/FIB 0.69 0.61 0.78 ESR/Ca 0.81 0.74 0.88 Markerscombination 0.89 0.84 0.94 OA-RA P <0.001 CRP 0.75 0.70 0.81 CRP/ESR 0.68 0.62 0.74 PTH/PLT 0.72 0.66 0.78 ESR/Ca 0.79 0.74 0.84 FIB/Ca 0.77 0.72 0.82 Markerscombination 0.84 0.79 0.88 GA-RA P <0.001 PTH 0.60 0.52 0.69 FIB 0.66 0.59 0.74 FIB/PLT 0.66 0.59 0.74 Markerscombination 0.73 0.66 0.81 Through linear logistic stepwise regression, inflammatory indicators, bone metabolism indicators, and related ratios were further screened, resulting in the selection of ESR, FIB, ESR/FIB, ESR/Ca, CRP, CRP/ESR, PTH/PLT, ESR/CA, FIB/CA, PTH, FIB, FIB/PLT as disease discrimination factors. The area under the curve (AUC) was used for evaluation, and the results showed that FIB had the highest AUC value in distinguishing OA and GA metabolites (Table 5 ). The AUC value of FIB in distinguishing OA and GA was 0.87 (95% CI: 0.82, 0.92), while the AUC value of the combined indicators was 0.89 (95% CI: 0.84, 0.94). There was no significant difference in the AUC values between FIB and the combined indicators (P = 0.1960). The AUC value of the combined indicators for OA and RA was 0.84 (95% CI: 0.79, 0.88), and the AUC value of the combined indicators was significantly higher than that of individual indicators ( P < 0.001 ). The AUC value of FIB in distinguishing between GA and RA was 0.66 (95% CI: 0.59, 0.74); the AUC value of the combined indicators was 0.73 (95% CI: 0.66, 0.81), and the AUC value of the combined indicators was significantly higher than that of individual indicators ( P < 0.001 ). 3 Discussion OA, GA, and RA are common inflammatory joint diseases in the rheumatology department. All three diseases involve varying degrees of inflammatory response and joint destruction during their course. The inflammatory markers studied in this article include CRP, ESR, FIB, and PLT. The inflammatory indicators include CRP, ESR, and PLT. CRP is a protein rapidly synthesized by liver cells when the body is infected or tissue is damaged, and it significantly increases during tissue injury, malignant tumors, and acute or chronic infections; ESR refers to the distance red blood cells settle in anticoagulated whole blood after one hour under certain conditions. Accelerated ESR can be seen in inflammatory diseases, tissue injury and necrosis, malignant tumors, etc. Related studies [ 14 ] have found that serum CRP and ESR can serve as important risk factors for RA onset, and ESR is positively correlated with symptoms such as morning stiffness and joint swelling and pain in RA patients. CRP and ESR show a significant upward trend during RA disease activity, with CRP [ 15 ] highly expressed in RA patients. PLT are anucleate cell fragments shed from megakaryocyte cytoplasm, playing an important role in coagulation, hemostasis, and thrombosis. Recent studies have found that besides hemostatic function, PLT also participate in innate immunity and inflammatory responses [ 16 ] . FIB is a plasma protein mainly synthesized by the liver, which increases reactively during inflammation, stress, and trauma. Under physiological conditions, FIB participates in hemostasis, coagulation, vascular remodeling, wound healing, and tissue repair under the action of thrombin. Some studies have pointed out [ 17 ] that FIB can serve as an independent factor for assessing disease activity in gout patients. Xue L [ 18 ] and others found that FIB levels in RA patients are significantly higher than in healthy individuals, and high FIB levels are associated with the degree of joint inflammation and synovial destruction in RA patients. Research shows [ 19 ] that plasma D-dimer and FIB levels in RA patients are related to the degree of joint destruction and disease activity. Routine clinical inflammatory markers CRP, ESR, and PLT are easily influenced by various factors and may only reflect inflammatory activity; all three have low specificity. The analysis of this study’s results suggests that FIB levels may be one of the effective and important indicators for differentiating OA, GA, and RA patients, with differences in disease levels among the three patient groups. This study found that compared to OA and RA patients, FIB levels are higher in GA patients, while FIB levels in OA patients are slightly lower than those in RA patients. Recent studies have shown correlations among inflammatory markers. He M [ 20 ] and others found that FIB is positively correlated with ESR and hypersensitive C-reactive protein (hs-CRP), and PLT is positively correlated with both ESR and hs-CRP, indicating that coagulation markers and inflammatory markers can influence each other in OA patients, with coagulation markers serving as important indicators of OA disease activity. Additionally, related research suggests a certain connection between the coagulation system and inflammatory response [ 21 ] , with a complex regulatory mechanism existing among inflammation, anticoagulation, coagulation, and fibrinolysis systems; the hemostasis and coagulation processes are accompanied by inflammatory responses. This study found positive correlations among the inflammatory markers ESR, FIB, CRP, and PLT. Combined with correlation analysis, it is evident that ESR, FIB, CRP, and PLT have good correlations in differentiating OA, GA, and RA. Logistic regression analysis of the AUC values for the ESR/FIB ratio, CRP/ESR ratio, and FIB/PLT ratio indicates that these ratios may play important roles in distinguishing among OA, GA, and RA diseases. Bone metabolism markers are important indicators for understanding the dynamic interactions between osteoclasts and osteoblasts in the body. In this study, bone metabolism markers include 25(OH)D, Ca, P, and PTH, all of which reflect the body's bone metabolism level. 25(OH)D is the active form of vitamin D in the body, which promotes calcium absorption and maintains bone metabolism balance by regulating calcium and phosphorus metabolism levels [ 22 ] . PTH is a polypeptide hormone secreted by the parathyroid glands, mainly involved in bone metabolism by regulating calcium and phosphorus metabolism levels, increasing blood calcium levels and decreasing blood phosphorus levels [ 23 ] . In this study, there were statistically significant differences in PTH and Ca levels among the three patient groups. The OA group had higher PTH and Ca levels than the GA and RA groups. PTH and P showed a negative correlation in RA and OA patients, indicating that as PTH levels increase, P levels relatively decrease. In RA patients, PTH levels were positively correlated with Ca. Combined with the Logistic regression results, PTH can be used to distinguish between GA and RA patients, and when combined with other markers, it can better differentiate these two diseases. The AUC values of PTH combined with other markers indicate its ability to distinguish between OA and RA patients. There is a correlation between inflammatory markers and bone metabolism markers. Studies have found that increased inflammation levels in patients with rheumatic autoimmune arthritis [ 24 – 26 ] can cause bone metabolism disorders and bone destruction. In this study, a negative correlation was observed between inflammatory markers and bone metabolism markers in the three patient groups. Combined with Logistic analysis, it was found that the ESR/Ca ratio, PTH/PLT ratio, and FIB/Ca ratio may play important roles in differentiating OA, GA, and RA diseases. In summary, this study found that FIB can serve as an important metabolic indicator to distinguish OA, GA, and RA diseases. FIB levels are higher in GA patients, slightly lower in RA patients compared to GA patients, and lower in OA patients. Additionally, FIB shows a positive correlation with ESR, CRP, and PLT. Furthermore, PTH levels can also be used to differentiate among OA, GA, and RA patients. There is a negative correlation between inflammatory markers and bone metabolism markers. FIB can satisfactorily distinguish between OA and GA, while combinations of indicators such as CRP, CRP/ESR, PTH/PLT, ESR/Ca, and FIB/Ca better differentiate OA and RA patients. At the same time, the combination of PTH, FIB, and FIB/PLT indicators better distinguishes GA and RA patients. The P/FIB ratio level in OA patients is higher than in GA and RA groups, with RA patients having a higher P/FIB ratio than GA patients. The FIB/Ca ratio level in GA patients is higher than in OA and RA groups, with RA patients having higher FIB/Ca levels than OA patients. Combined with Logistic regression results, it was found that FIB and related indicator combinations play an important role in distinguishing OA, GA, and RA diseases. It is thus concluded that FIB, the P/FIB ratio, and the FIB/Ca ratio show significant differences among OA, GA, and RA patients and can be used to differentiate these patients. Moreover, related indicator combinations may also be used to distinguish OA, GA, and RA patients. Abbreviations AUC Area under the curve BMI Bodymass index CRP C-reactive protein Ca Calcium DBP Diastolic blood pressure ESR Sedimentation rate FIB Fibrinogen GA Gouty arthritis OA Osteoarthritis PTH Parathyroid hormone PLT Platelet P Phosphorus RA Rheumatoid arthritis SBP Systolic blood pressure hs-CRP C-reactive protein 25(OH)D 25-hydroxyvitamin D Declarations Author contributions XW and ZL contributed to the conception and design. XW wrote the manuscript. YL, SL, and XW contributed to acquisition of data and data analysis. All authors contributed to the article and approved the submitted version. Funding This work was supported by the Program of the National Natural Science Foundation of China (Grant No.82405366), Guizhou Provincial Clinical Research Center for Traditional Chinese Medicine in Rheumatic and Immunological Diseases [Qiankehe Platform Talent (202222)]. Availability of data and materials The data are sourced from The Second Affiliated Hospital of Guizhou University of Traditional Chinese Medicine. Due to the need for further data analysis and reuse by the data committee, other data analyses are being conducted. The data that support the findings of this study are available on request from the corresponding author XW on reasonable request. Ethics approval and consent to participate This study was approved by the Medical Ethics Committee of the Second Affiliated Hospital of Guizhou University of Traditional Chinese Medicine (LW20240718) and exempted from signing patient informed consent forms. Competing interests The authors declare no competing interests. References Abramoff B, Caldera FE. Osteoarthritis: Pathology, Diagnosis, and Treatment Options [J].Med Clin North Am. 2020;104(2):293-311. Abramoff, Benjamin, Franklin E Caldera. “Osteoarthritis: Pathology, Diagnosis, and Treatment Options.” [J].The Medical clinics of North America vol. 104,2 (2020): 293-311. Dumusc A, So A. Advances in treatment of hyperuricemia and gout. Die Zukunft der Gichttherapie.Ther Umsch. 2024;81(5):168-171. Du L, Zong Y, Li H, et al. Hyperuricemia and its related diseases: mechanisms and advances in therapy.Signal Transduct Target Ther. 2024;9(1):212. Published 2024 Aug 28. Díaz-González, Federico, María V Hernández-Hernández. “Rheumatoid arthritis.” “Artritis reumatoide.” [J]. Medicina clinica vol. 161,12 (2023): 533-542. Jang S,Kwon EJ, Lee JJ. Rheumatoid Arthritis: Pathogenic Roles of Diverse Immune Cells [J].Int J Mol Sci. 2022;23(2):905. Published 2022 Jan 14. Zhang J. Clinical Analysis of 22 Misdiagnosed Cases of Rheumatoid Arthritis [J]. Jiangxi Medical Journal. 2021;56(09):1425 - 1427. Zhang J, Zou M, Chi J, et al. Value of Joint Fluid and Blood-related Indicators in the Diagnosis of Gouty Arthritis and Rheumatoid Arthritis [J]. West China Medical Journal. 2016;31(08):1376-1379. Zhang W, Doherty M, Peat G, et al. EULAR evidence-based recommendations for the diagnosis of knee osteoarthritis [J]. Ann Rheum Dis. 2010;69(3):483-489. Neogi T, Jansen TLTA, Dalbeth N, et al. 2015 Gout classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative [J]. Ann Rheum Dis.2015;74(10):1789-1798. Singh JA, Saag KG, Bridges SL, et al. 2015 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis. Arthritis Rheumatol Hoboken NJ [J].2016;68(1):1-26. Orr CK, Najm A, Young F, et al. The Utility and Limitations of CRP, ESR and DAS28-CRP in Appraising Disease Activity in Rheumatoid Arthritis. Front Med (Lausanne). 2018 Aug 3;5:185. Kilcher G, Hummel N, Didden EM, et al.Rheumatoid arthritis patients treated in trial and real world settings: comparison of randomized trials with registries. Rheumatology (Oxford). 2018 Feb 1;57(2):354-369. Maouia A, Rebetz J, Kapur R, et al. The Immune Nature of Platelets Revisited. Transfus Med Rev. 2020 Oct;34(4):209-220. Chen S, Huang X, Huang Y, et al. Role of plasma fibrinogen in assessing disease activity of patients with gout. Clin Chim Acta. 2020 Nov;510:483-487. Xue L, Tao L, Li X, Wang Y, et al. D-dimer, and fibrin degradation product as biomarkers of rheumatoid arthritis. Sci Rep. 2021 Aug 19;11(1):16903. Qiang F, Xu H, Sheng J. Relationship between plasma fibrinogen degradation products(FDP) and D-dimer levels and disease activity in rheumatoid arthritis: A STROBE compliant article. Medicine (Baltimore). 2022 Sep 9;101(36):e30455. He M, Liu J, Xin L, et al. Changes of coagulation indexes and correlation analysis betweenthem,immunity indexes,inflammation indexes and lipid metabolismindexes in 717 cases of patients with osteoarthritis [J].Journal of Gansu University of Chinese Medicine. 2021;38(03):68-73. Levi M, van der Poll T. Inflammation and coagulation. Crit Care Med. 2010 Feb;38(2 Suppl):S26-34. Sîrbe C, Rednic S, Grama A, et al. An Update on the Effects of Vitamin D on the Immune System and Autoimmune Diseases. Int J Mol Sci. 2022 Aug 29;23(17):9784. Goltzman D, Mannstadt M, Marcocci C. Physiology of the Calcium-Parathyroid Hormone-Vitamin D Axis. Front Horm Res. 2018;50:1-13. Maeda K, Yoshida K, Nishizawa T, et al. Inflammation and Bone Metabolism in Rheumatoid Arthritis: Molecular Mechanisms of Joint Destruction and Pharmacological Treatments. Int J Mol Sci. 2022 Mar 6;23(5):2871. Komatsu N, Takayanagi H. Mechanisms of joint destruction in rheumatoid arthritis - immune cell-fibroblast-bone interactions. Nat Rev Rheumatol. 2022 Jul;18(7):415-429. Du X, Liu ZY, Tao XX, et al. Research Progress on the Pathogenesis of Knee Osteoarthritis. Orthop Surg. 2023 Sep;15(9):2213-2224. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7193571","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":493244538,"identity":"be60280e-0291-40b7-8a23-6dca73cd5e3d","order_by":0,"name":"Yongting Liu","email":"","orcid":"","institution":"The Second Affiliated Hospital of Guizhou University of Traditional Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Yongting","middleName":"","lastName":"Liu","suffix":""},{"id":493244539,"identity":"d1be8682-9fba-4905-af99-13aaaa4e7a14","order_by":1,"name":"Shanshan Liu","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Shanshan","middleName":"","lastName":"Liu","suffix":""},{"id":493244540,"identity":"0d8b3d30-3818-4907-876d-804f7c797a15","order_by":2,"name":"Jianhui Ma","email":"","orcid":"","institution":"The Second Affiliated Hospital of Guizhou University of Traditional Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Jianhui","middleName":"","lastName":"Ma","suffix":""},{"id":493244541,"identity":"8c40d348-f2af-4d9c-843d-4da62df73397","order_by":3,"name":"Yi Ling","email":"","orcid":"","institution":"The Second Affiliated Hospital of Guizhou University of Traditional Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Yi","middleName":"","lastName":"Ling","suffix":""},{"id":493244542,"identity":"85ad86c0-95de-44c0-a7f5-dfb6da40a050","order_by":4,"name":"Xue Wu","email":"","orcid":"","institution":"The Second Affiliated Hospital of Guizhou University of Traditional Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Xue","middleName":"","lastName":"Wu","suffix":""},{"id":493244543,"identity":"20cc43f9-1f27-4912-a28e-851c2c69b595","order_by":5,"name":"Zhengqi Liu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA1ElEQVRIiWNgGAWjYBACPgYeMM3Dxt584MCHH0RoYYNp4eM5lnhwZg8JWhjkJHKMD3OwEaOF/+zBxwW/rGXYGHI+HAbql+cXO0DIlnPJxjP70nnYGM5uOFxgwWA4c3YCAS2MPWbSvD2HedgYezccnsHDkGBwm5AWZh7z32AtzDwPgCQxWth4zJh5fgAVs/EwEKmFh8dYmrcB6BceNgNgIEsQ9gs//xnDzzx/rO3l5z9+/OHDDxt5fmkCWsCAsY0ZxpQgQjkY/GEmrGYUjIJRMApGLgAACKo7Guf8PbUAAAAASUVORK5CYII=","orcid":"","institution":"The Second Affiliated Hospital of Guizhou University of Traditional Chinese Medicine","correspondingAuthor":true,"prefix":"","firstName":"Zhengqi","middleName":"","lastName":"Liu","suffix":""}],"badges":[],"createdAt":"2025-07-23 07:53:29","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7193571/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7193571/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":88037788,"identity":"4558644e-226e-4b45-b500-6d8ec338bcb2","added_by":"auto","created_at":"2025-07-31 16:33:24","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":70265,"visible":true,"origin":"","legend":"\u003cp\u003eCorrelation between inflammatory indicators and bone metabolism markers in OA, GA, and RA patients\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7193571/v1/cea958dee89320e4690d7438.jpeg"},{"id":90639796,"identity":"20d752c6-f70e-4908-8c1b-2d8dd9f67238","added_by":"auto","created_at":"2025-09-05 06:17:12","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1146444,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7193571/v1/1bb59316-1ade-4833-9099-32201b9c5ebf.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Differential expression and correlation of inflammatory markers and bone metabolism markers in osteoarthritis, gouty arthritis and rheumatoid arthritis:a retrospective cohort study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eCommon bone and joint diseases in rheumatology include OA, GA, RA,etc. OA is the most common chronic degenerative disease of the bone and joints in clinical practice \u003csup\u003e[1,2]\u003c/sup\u003e, characterized by Degeneration of articular cartilage as well as changes in subchondral bone, synovium and surrounding joint tissues, with clinical manifestations of persistent joint pain, tenderness, bone friction sounds, joint deformity and dysfunction, which seriously affects the quality of life of patients \u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e.GA is associated with disturbances in purine metabolism and/or impaired excretion of uric acid, and it is a crystalline arthropathy in which single-sodium urates are deposited in the joints, and the clinical manifestations can be seen as affected joints often presenting with varying degrees of pain, Clinical manifestations show that the affected joints often have different degrees of pain, pressure and swelling, and some of the soft tissues around the joints can be seen as gout stone deposits \u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e. In addition, RA is a chronic, systemic autoimmune disease \u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e, is mainly characterized by erosive and symmetric synovitis and multi-system involvement, and can accumulate multiple organ systems such as the eye, heart, brain, kidney, etc. \u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e, whose basic pathological changes are synovitis leading to synovial abnormal proliferation, destruction of cartilage, bone, and joint capsule of affected joints, and the clinical manifestations of joint pain with swelling, The clinical manifestations are joint pain with swelling, stiffness and induration \u003csup\u003e[8]\u003c/sup\u003e, and in advanced stages, it can lead to joint deformity and loss of joint movement function. In summary, all three diseases can cause bone and joint destruction and deformity.\u003c/p\u003e\u003cp\u003eOA, GA, and RA belong to the same joint diseases, the etiology and pathogenesis of the three are different and complex, but the clinical manifestations are similar, there are different degrees of osteoarticular pain and bone destruction, missed diagnosis, misdiagnosis of cases have been reported, gouty arthritis is easy to misdiagnose rheumatoid arthritis, osteoarthritis is also often misdiagnosed as rheumatoid arthritis, in addition, the same patient may be suffering from two or three diseases at the same time, for example, patients with gouty arthritis are combined with rheumatoid arthritis. Gouty arthritis patients with rheumatoid arthritis. It was found \u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e that among 22 hospitalized patients initially diagnosed with rheumatoid arthritis, 12 cases were misdiagnosed as OA, 5 cases as rheumatoid RA, 4 cases as GA, and 1 case as septic arthritis in the later stage of the follow-up, so it is of great significance for the diagnosis of the disease, patient treatment, and prognosis to screen out disease-specific indexes and to reduce the disease misdiagnosis and underdiagnosis.\u003c/p\u003e\u003cp\u003eAt present, the early diagnosis of OA, GA, and RA is based on relevant laboratory markers and imaging tests, and patients in some areas rely only on imaging tests; however, imaging tests have a relative lag, and the appearance of imaging joint destruction is already at an advanced stage, resulting in irreversible joint deformity and joint dysfunction in patients. Clinically, patients already have abnormal laboratory markers in the early stage of the disease, and some studies have found \u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e that CRP levels are significantly higher in rheumatoid arthritis patients than in gouty arthritis. Currently, there are fewer studies on the screening of markers distinguishing these three diseases by inflammatory markers and bone metabolism markers, and their correlation still needs to be investigated. Therefore, retrospective analysis of inflammatory markers and bone metabolism markers in patients with OA, GA, and RA, clarifying the correlation of inflammatory markers and bone metabolism markers among the three, and establishing a model for the differentiation of the three diseases of OA, GA, and RA, will provide support for earlier and more accurate diagnosis of the diseases, and will be of great clinical significance for the progression of patients' conditions and prevention.\u003c/p\u003e"},{"header":"1 Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003e1.1 Clinical data\u003c/h2\u003e\u003cp\u003eA total of 373 hospitalized patients from the Department of Rheumatology and Immunology at the Second Affiliated Hospital of Guizhou University of Traditional Chinese Medicine between June 2016 and February 2020 were selected as research subjects. The OA group consisted of 138 cases, with 22 males and 116 females, and an average age of (69.90\u0026thinsp;\u0026plusmn;\u0026thinsp;12.10) years. The GA group had 72 cases, with 70 males and 2 females, and an average age of (60.72\u0026thinsp;\u0026plusmn;\u0026thinsp;12.03) years; the RA group included 163 cases, with 59 males and 104 females, and an average age of (62.09\u0026thinsp;\u0026plusmn;\u0026thinsp;10.18) years. There were statistically significant differences in gender and age among the three groups (\u003cem\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/em\u003e). The collected inflammatory markers included CRP, ESR, FIB and PLT. Bone metabolism markers included 25-hydroxyvitamin D (25(OH)D), calcium (Ca), phosphorus (P), and parathyroid hormone (PTH).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003e1.2 Inclusion criteria\u003c/h2\u003e\u003cp\u003e① OA was based on the 2009 EULAR diagnostic criteria \u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e, GA was based on the 2015 ACR/EULAR diagnostic criteria for gout \u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e, and RA was based on the 2015 ACR/EULAR diagnostic criteria \u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e.②Age 18 years or older and gender was not limited.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003e1.3 Exclusion criteria\u003c/h2\u003e\u003cp\u003e①those who did not meet the above diagnostic criteria; ②patients with other causes of peripheral arthropathy; ③ those with other critical illnesses; ④ patients with fever, infection, bleeding and surgical treatment; ⑤those with seriously incomplete data. This study was approved by the Ethics Committee of the Second Affiliated Hospital of Guizhou University of Traditional Chinese Medicine (approval number: lw20240718).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003e1.4 Statistical methods\u003c/h2\u003e\u003cp\u003eSPSS26.0 software was used for statistical analysis, and the measurements were expressed as(\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\stackrel{-}{x}\\)\u003c/span\u003e\u003c/span\u003e\u003cem\u003e\u0026plusmn;sd\u003c/em\u003e), and the count data were expressed as n (%), according to the results of the normality test, t-test was used for those with normal distribution; and non-parametric test was used for those with non-normal distribution. Two-by-two comparisons were performed using the Kruskal-wallis test, multifactor correlation analysis was performed using the Pearson test, binary stepwise logistic regression was used to screen the variables, binary logistic regression analysis was used to establish a model distinguishing between OA, GA, and RA, and the area under the curve (AUC) of the ROC curve was used to evaluation and comparison, and the difference was considered statistically significant at \u003cem\u003eP\u0026lt;0.05\u003c/em\u003e.\u003c/p\u003e\u003c/div\u003e"},{"header":"2 Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003e2.1 Basic information statistics of OA, GA, RA patients\u003c/h2\u003e\u003cp\u003eComparing the basic information of 373 patients in the clinic, the differences between the three groups of OA, GA, and RA patients in terms of gender, age, height, weight, and bodymass index (BMI) were statistically significant (\u003cem\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/em\u003e). And the differences in systolic blood pressure (SBP) (P\u0026thinsp;=\u0026thinsp;0.265) and diastolic blood pressure (DBP) (\u003cem\u003eP\u0026thinsp;=\u0026thinsp;0.569\u003c/em\u003e) were not statistically significant(Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of basic information about OA, GA, and RA diseases(\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\stackrel{-}{x}\\)\u003c/span\u003e\u003c/span\u003e\u003cem\u003e\u0026plusmn;sd\u003c/em\u003e)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOA(n\u0026thinsp;=\u0026thinsp;138)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eGA(n\u0026thinsp;=\u0026thinsp;72)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRA(n\u0026thinsp;=\u0026thinsp;163)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003esex Man\u003c/p\u003e\u003cp\u003eWomen\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e22(15.94%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e70(97.22%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e59(36.19%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e116(84.05%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2(2.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e104(63.80%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e69.90\u0026thinsp;\u0026plusmn;\u0026thinsp;12.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e60.72\u0026thinsp;\u0026plusmn;\u0026thinsp;12.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e62.09\u0026thinsp;\u0026plusmn;\u0026thinsp;10.18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSBP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e128.54\u0026thinsp;\u0026plusmn;\u0026thinsp;14.54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e125.49\u0026thinsp;\u0026plusmn;\u0026thinsp;16.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e127.23\u0026thinsp;\u0026plusmn;\u0026thinsp;17.51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.265\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDBP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e75.81\u0026thinsp;\u0026plusmn;\u0026thinsp;10.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e75.99\u0026thinsp;\u0026plusmn;\u0026thinsp;12.22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e77.31\u0026thinsp;\u0026plusmn;\u0026thinsp;10.20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.569\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBMI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e23.48\u0026thinsp;\u0026plusmn;\u0026thinsp;3.16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e23.75\u0026thinsp;\u0026plusmn;\u0026thinsp;3.40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e21.98\u0026thinsp;\u0026plusmn;\u0026thinsp;3.21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHeight\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e157.41\u0026thinsp;\u0026plusmn;\u0026thinsp;6.49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e164.11\u0026thinsp;\u0026plusmn;\u0026thinsp;7.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e159.52\u0026thinsp;\u0026plusmn;\u0026thinsp;7.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eweight\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e58.28\u0026thinsp;\u0026plusmn;\u0026thinsp;9.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e64.06\u0026thinsp;\u0026plusmn;\u0026thinsp;10.46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e56.05\u0026thinsp;\u0026plusmn;\u0026thinsp;9.62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003csup\u003ea\u003c/sup\u003e The significance values have been adjusted using the Bonferroni correction method\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003e2.2 Comparative Analysis of Inflammatory markers in OA, GA, and RA Patients\u003c/h2\u003e\u003cp\u003eThrough the comparison of inflammatory markers among OA, GA, and RA patients, it can be concluded that the differences in the levels of inflammatory markers CRP, ESR, FIB, and PLT among the three groups are statistically significant (\u003cem\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/em\u003e); pairwise comparisons between groups found that the levels of CRP, ESR, and FIB in the GA group were higher than those in the OA and RA groups (\u003cem\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/em\u003e); the FIB level in the GA group was higher than that in the OA and RA groups (\u003cem\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/em\u003e), while the FIB level in the RA group was higher than that in the OA group. The PLT levels in the GA and RA groups were higher than those in the OA group (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e ).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of inflammatory markers levels in OA, GA, and RA diseases(\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\stackrel{-}{x}\\)\u003c/span\u003e\u003c/span\u003e\u003cem\u003e\u0026plusmn;sd\u003c/em\u003e)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInflammatory markers\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOA\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eGA\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRA\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCRP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e1.45\u0026thinsp;\u0026plusmn;\u0026thinsp;6.69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e7.06\u0026thinsp;\u0026plusmn;\u0026thinsp;15.34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e5.21\u0026thinsp;\u0026plusmn;\u0026thinsp;13.34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u0026lt;0.001\u003csup\u003e*▲\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eESR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e20.79\u0026thinsp;\u0026plusmn;\u0026thinsp;19.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e54.42\u0026thinsp;\u0026plusmn;\u0026thinsp;35.47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e53.25\u0026thinsp;\u0026plusmn;\u0026thinsp;35.63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u0026lt;0.001\u003csup\u003e*▲\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFIB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e3.04\u0026thinsp;\u0026plusmn;\u0026thinsp;1.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e5.36\u0026thinsp;\u0026plusmn;\u0026thinsp;1.69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e4.38\u0026thinsp;\u0026plusmn;\u0026thinsp;1.62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u0026lt;0.001\u003csup\u003e*▲△\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePLT\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e211.72\u0026thinsp;\u0026plusmn;\u0026thinsp;68.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e260.31\u0026thinsp;\u0026plusmn;\u0026thinsp;107.99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e283.04\u0026thinsp;\u0026plusmn;\u0026thinsp;120.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u0026lt;0.001\u003csup\u003e*▲\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e*\u003cem\u003eP\u003c/em\u003e\u0026lt;0.05:Comparison between the OA group and the RA group\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003csup\u003e▲\u003c/sup\u003e\u003cem\u003eP\u003c/em\u003e\u0026lt;0.05:Comparison between the OA group and the GA group;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003csup\u003e△\u003c/sup\u003e\u003cem\u003eP\u003c/em\u003e\u0026lt;0.05:Comparison between the RA group and the GA group\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003csup\u003ea\u003c/sup\u003e The significance values have been adjusted using the Bonferroni correction method\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\u003ch2\u003e2.3 Comparative Analysis of Bone Metabolism Markers in OA, GA, and RA Patients\u003c/h2\u003e\u003cp\u003eThe results of the inter-group comparison of bone metabolism markers in OA, GA, and RA patients show that the levels of two metabolites, PTH and Ca, are significantly different among the three groups (\u003cem\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/em\u003e); pairwise comparisons between groups reveal that the PTH level in the RA group is significantly lower than that in the OA and GA groups (\u003cem\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/em\u003e); the Ca level in the RA group is slightly lower than that in the GA group (\u003cem\u003eP\u0026thinsp;=\u0026thinsp;0.016\u003c/em\u003e) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e ).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of bone metabolism markers levels in OA, GA, and RA diseases(\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\stackrel{-}{x}\\)\u003c/span\u003e\u003c/span\u003e\u003cem\u003e\u0026plusmn;sd\u003c/em\u003e)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eBone metabolism markers\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eOA\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eGA\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eRA\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e25-OH-VD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e20.60\u0026thinsp;\u0026plusmn;\u0026thinsp;8.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e22.99\u0026thinsp;\u0026plusmn;\u0026thinsp;10.82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e21.30\u0026thinsp;\u0026plusmn;\u0026thinsp;9.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.355\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePTH\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e58.72\u0026thinsp;\u0026plusmn;\u0026thinsp;34.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e55.54\u0026thinsp;\u0026plusmn;\u0026thinsp;31.99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e44.14\u0026thinsp;\u0026plusmn;\u0026thinsp;22.84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u0026lt;0.001\u003csup\u003e*△\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e1.19\u0026thinsp;\u0026plusmn;\u0026thinsp;0.31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.17\u0026thinsp;\u0026plusmn;\u0026thinsp;0.31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.16\u0026thinsp;\u0026plusmn;\u0026thinsp;0.25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.749\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCa\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e2.38\u0026thinsp;\u0026plusmn;\u0026thinsp;0.22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.34\u0026thinsp;\u0026plusmn;\u0026thinsp;0.18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.32\u0026thinsp;\u0026plusmn;\u0026thinsp;0.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.016\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003csup\u003e*\u003c/sup\u003e\u003cem\u003eP\u003c/em\u003e\u0026lt;0.05:Comparison between the OA group and the RA group;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003csup\u003e△\u003c/sup\u003e\u003cem\u003eP\u003c/em\u003e\u0026lt;0.05:Comparison between the RA group and the GA group\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003csup\u003ea\u003c/sup\u003e The significance values have been adjusted using the Bonferroni correction method\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e2.4 Comparison and analysis of inflammatory indicators and bone metabolism marker ratios in OA, GA, and RA patients.\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe comparative analysis of inflammatory indicators and bone metabolism marker ratios among the OA, GA, and RA patient groups showed statistically significant differences in the ratios of CRP/25(OH)D, CRP/PTH, CRP/P, CRP/ESR, CRP/FIB, CRP/PLT, CRP/Ca, 25(OH)D/PTH, 25(OH)D/ESR, 25(OH)D/FIB, 25(OH)D/PLT, PTH/P, PTH/ESR, PTH/FIB, PTH/PLT, PTH/Ca, P/ESR, P/FIB, P/PLT, ESR/FIB, ESR/PLT, ESR/Ca, FIB/PLT, FIB/Ca, and PLT/Ca (\u003cem\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/em\u003e). Pairwise comparisons of the above ratios revealed that the levels of CRP/25(OH)D, CRP/PTH, CRP/P, CRP/ESR, CRP/FIB, CRP/PLT, CRP/Ca, ESR/FIB, ESR/PLT, ESR/Ca, FIB/Ca, and PLT/Ca in the OA group were lower than those in the GA and RA groups (\u003cem\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/em\u003e); the 25(OH)D/PTH ratio in the OA group was lower than that in the RA group; the 25(OH)D/ESR, 25(OH)D/FIB, PTH/ESR, PTH/FIB, PTH/PLT, P/ESR, P/FIB, and P/PLT ratios in the GA and RA groups were all lower than those in the OA group (\u003cem\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/em\u003e); the 25(OH)D/PLT ratio in the OA group was higher than that in the RA group (P\u0026thinsp;=\u0026thinsp;0.012); the PTH/P and PTH/Ca ratio levels in the RA group were lower than those in the OA and GA groups (\u003cem\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/em\u003e); the FIB/PLT ratio in the OA and RA groups was lower than that in the GA group (\u003cem\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/em\u003e); the P/FIB ratio levels in the OA group were higher than those in the GA and RA groups, with the RA group having a higher P/FIB than the GA group (\u003cem\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/em\u003e); the FIB/Ca ratio levels in the GA group were higher than those in the OA and RA groups, while the FIB/Ca level in the RA patients was higher than that in the OA patients (\u003cem\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/em\u003e) (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of inflammatory indicators and bone metabolism biomarker ratios in OA, GA, and RA diseases(\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\stackrel{-}{x}\\)\u003c/span\u003e\u003c/span\u003e\u003cem\u003e\u0026plusmn;sd\u003c/em\u003e)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMetabolic indicators\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOA\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eGA\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRA\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCRP/25(OH)D\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.08\u0026thinsp;\u0026plusmn;\u0026thinsp;0.35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.49\u0026thinsp;\u0026plusmn;\u0026thinsp;1.28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.31\u0026thinsp;\u0026plusmn;\u0026thinsp;0.93\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u0026lt;0.001\u003csup\u003e*▲\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCRP/PTH\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.03\u0026thinsp;\u0026plusmn;\u0026thinsp;0.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.23\u0026thinsp;\u0026plusmn;\u0026thinsp;0.78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.20\u0026thinsp;\u0026plusmn;\u0026thinsp;0.65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u0026lt;0.001\u003csup\u003e*▲\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCRP/P\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.24\u0026thinsp;\u0026plusmn;\u0026thinsp;5.47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6.11\u0026thinsp;\u0026plusmn;\u0026thinsp;11.32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.50\u0026thinsp;\u0026plusmn;\u0026thinsp;11.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u0026lt;0.001\u003csup\u003e*▲\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCRP/ESR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.04\u0026thinsp;\u0026plusmn;\u0026thinsp;0.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.15\u0026thinsp;\u0026plusmn;\u0026thinsp;0.40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.10\u0026thinsp;\u0026plusmn;\u0026thinsp;0.20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u0026lt;0.001\u003csup\u003e*▲\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCRP/FIB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.32\u0026thinsp;\u0026plusmn;\u0026thinsp;1.22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.19\u0026thinsp;\u0026plusmn;\u0026thinsp;2.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.30\u0026thinsp;\u0026plusmn;\u0026thinsp;3.73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u0026lt;0.001\u003csup\u003e*▲\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCRP/PLT\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.01\u0026thinsp;\u0026plusmn;\u0026thinsp;0.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.03\u0026thinsp;\u0026plusmn;\u0026thinsp;0.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.02\u0026thinsp;\u0026plusmn;\u0026thinsp;0.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u0026lt;0.001\u003csup\u003e*▲\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCRP/Ca\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.59\u0026thinsp;\u0026plusmn;\u0026thinsp;2.68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.03\u0026thinsp;\u0026plusmn;\u0026thinsp;6.24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.28\u0026thinsp;\u0026plusmn;\u0026thinsp;5.76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u0026lt;0.001\u003csup\u003e*▲\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e25(OH)D/PTH\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.45\u0026thinsp;\u0026plusmn;\u0026thinsp;0.31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.58\u0026thinsp;\u0026plusmn;\u0026thinsp;0.50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.61\u0026thinsp;\u0026plusmn;\u0026thinsp;0.42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.001\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e25(OH)D/P\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18.13\u0026thinsp;\u0026plusmn;\u0026thinsp;8.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20.91\u0026thinsp;\u0026plusmn;\u0026thinsp;10.84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e18.98\u0026thinsp;\u0026plusmn;\u0026thinsp;8.85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.206\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e25(OH)D/ESR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.82\u0026thinsp;\u0026plusmn;\u0026thinsp;2.93\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.82\u0026thinsp;\u0026plusmn;\u0026thinsp;0.95\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.92\u0026thinsp;\u0026plusmn;\u0026thinsp;1.38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u0026lt;0.001\u003csup\u003e*▲\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e25(OH)D/FIB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7.30\u0026thinsp;\u0026plusmn;\u0026thinsp;3.36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.85\u0026thinsp;\u0026plusmn;\u0026thinsp;3.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5.93\u0026thinsp;\u0026plusmn;\u0026thinsp;6.24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u0026lt;0.001\u003csup\u003e*▲\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e25(OH)D/PLT\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.11\u0026thinsp;\u0026plusmn;\u0026thinsp;0.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.13\u0026thinsp;\u0026plusmn;\u0026thinsp;0.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.09\u0026thinsp;\u0026plusmn;\u0026thinsp;0.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003eP\u0026thinsp;=\u003c/em\u003e\u0026thinsp;0.012\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e25(OH)D/Ca\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8.72\u0026thinsp;\u0026plusmn;\u0026thinsp;3.54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9.80\u0026thinsp;\u0026plusmn;\u0026thinsp;4.53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9.19\u0026thinsp;\u0026plusmn;\u0026thinsp;3.94\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003eP\u0026thinsp;=\u003c/em\u003e\u0026thinsp;0.267\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePTH/P\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e52.86\u0026thinsp;\u0026plusmn;\u0026thinsp;34.79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e53.01\u0026thinsp;\u0026plusmn;\u0026thinsp;38.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e41.03\u0026thinsp;\u0026plusmn;\u0026thinsp;27.62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u0026lt;0.001\u003csup\u003e*△\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePTH/ESR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5.57\u0026thinsp;\u0026plusmn;\u0026thinsp;8.65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.35\u0026thinsp;\u0026plusmn;\u0026thinsp;3.60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.94\u0026thinsp;\u0026plusmn;\u0026thinsp;2.84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u0026lt;0.001\u003csup\u003e*▲\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePTH/FIB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e21.35\u0026thinsp;\u0026plusmn;\u0026thinsp;13.90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12.08\u0026thinsp;\u0026plusmn;\u0026thinsp;8.99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e13.80\u0026thinsp;\u0026plusmn;\u0026thinsp;24.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u0026lt;0.001\u003csup\u003e*▲\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePTH/PLT\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.31\u0026thinsp;\u0026plusmn;\u0026thinsp;0.22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.30\u0026thinsp;\u0026plusmn;\u0026thinsp;0.30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.19\u0026thinsp;\u0026plusmn;\u0026thinsp;0.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u0026lt;0.001\u003csup\u003e*▲\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePTH/Ca\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e24.78\u0026thinsp;\u0026plusmn;\u0026thinsp;14.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e23.76\u0026thinsp;\u0026plusmn;\u0026thinsp;13.73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e19.02\u0026thinsp;\u0026plusmn;\u0026thinsp;9.78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u0026lt;0.001\u003csup\u003e*△\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eP/ESR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.10\u0026thinsp;\u0026plusmn;\u0026thinsp;0.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.04\u0026thinsp;\u0026plusmn;\u0026thinsp;0.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.05\u0026thinsp;\u0026plusmn;\u0026thinsp;0.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u0026lt;0.001\u003csup\u003e*▲\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eP/FIB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.43\u0026thinsp;\u0026plusmn;\u0026thinsp;0.16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.25\u0026thinsp;\u0026plusmn;\u0026thinsp;0.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.35\u0026thinsp;\u0026plusmn;\u0026thinsp;0.61\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u0026lt;0.001\u003csup\u003e*▲△\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eP/PLT\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.01\u0026thinsp;\u0026plusmn;\u0026thinsp;0.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.01\u0026thinsp;\u0026plusmn;\u0026thinsp;0.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.00\u0026thinsp;\u0026plusmn;\u0026thinsp;0.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u0026lt;0.001\u003csup\u003e*▲\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eP/Ca\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.50\u0026thinsp;\u0026plusmn;\u0026thinsp;0.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.50\u0026thinsp;\u0026plusmn;\u0026thinsp;0.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.50\u0026thinsp;\u0026plusmn;\u0026thinsp;0.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.926\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eESR/FIB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6.34\u0026thinsp;\u0026plusmn;\u0026thinsp;3.99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10.06\u0026thinsp;\u0026plusmn;\u0026thinsp;6.45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e15.70\u0026thinsp;\u0026plusmn;\u0026thinsp;48.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u0026lt;0.001\u003csup\u003e*▲\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eESR/PLT\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.10\u0026thinsp;\u0026plusmn;\u0026thinsp;0.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.24\u0026thinsp;\u0026plusmn;\u0026thinsp;0.22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.20\u0026thinsp;\u0026plusmn;\u0026thinsp;0.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u0026lt;0.001\u003csup\u003e*▲\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eESR/Ca\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8.73\u0026thinsp;\u0026plusmn;\u0026thinsp;8.41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e23.86\u0026thinsp;\u0026plusmn;\u0026thinsp;16.56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e23.40\u0026thinsp;\u0026plusmn;\u0026thinsp;16.28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u0026lt;0.001\u003csup\u003e*▲\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFIB/PLT\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.02\u0026thinsp;\u0026plusmn;\u0026thinsp;0.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.03\u0026thinsp;\u0026plusmn;\u0026thinsp;0.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.02\u0026thinsp;\u0026plusmn;\u0026thinsp;0.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u0026lt;0.001\u003csup\u003e▲△\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFIB/Ca\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.28\u0026thinsp;\u0026plusmn;\u0026thinsp;0.46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.31\u0026thinsp;\u0026plusmn;\u0026thinsp;0.77\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.91\u0026thinsp;\u0026plusmn;\u0026thinsp;0.74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u0026lt;0.001\u003csup\u003e* ▲△\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePLT/Ca\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e89.10\u0026thinsp;\u0026plusmn;\u0026thinsp;28.83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e111.76\u0026thinsp;\u0026plusmn;\u0026thinsp;46.44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e123.36\u0026thinsp;\u0026plusmn;\u0026thinsp;55.75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u0026lt;0.001\u003csup\u003e*▲\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e*\u003cem\u003eP\u003c/em\u003e\u0026lt;0.05:Comparison between the OA group and the RA group\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003csup\u003e▲\u003c/sup\u003e\u003cem\u003eP\u003c/em\u003e\u0026lt;0.05:Comparison between the OA group and the GA group;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003csup\u003e△\u003c/sup\u003e\u003cem\u003eP\u003c/em\u003e\u0026lt;0.05:Comparison between the RA group and the GA group\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003csup\u003ea\u003c/sup\u003e The significance values have been adjusted using the Bonferroni correction method\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003e2.5 Correlation analysis of OA, GA, and RA patients\u003c/h2\u003e\u003cp\u003eThrough Pearson correlation analysis, the interrelationships among inflammatory indicators and bone metabolism markers in the three groups of patients (OA, GA, RA) were assessed. From Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, it can be seen that in the OA group, CRP is positively correlated with ESR (\u003cem\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/em\u003e) and FIB (\u003cem\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/em\u003e). ESR is positively correlated with FIB (\u003cem\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/em\u003e) and PLT (\u003cem\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/em\u003e). FIB is positively correlated with PLT (\u003cem\u003eP\u0026thinsp;=\u0026thinsp;0.005\u003c/em\u003e), and PLT is positively correlated with Ca (\u003cem\u003eP\u0026thinsp;=\u0026thinsp;0.022\u003c/em\u003e). 25(OH)D is negatively correlated with PTH (\u003cem\u003eP\u0026thinsp;=\u0026thinsp;0.032\u003c/em\u003e), and P is positively correlated with Ca (\u003cem\u003eP\u0026thinsp;=\u0026thinsp;0.003\u003c/em\u003e).\u003c/p\u003e\u003cp\u003eIn the GA group, CRP was positively correlated with ESR (\u003cem\u003eP\u0026thinsp;=\u0026thinsp;0.049\u003c/em\u003e) and FIB (\u003cem\u003eP\u0026thinsp;=\u0026thinsp;0.021\u003c/em\u003e); ESR was positively correlated with FIB (\u003cem\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/em\u003e) and PLT (\u003cem\u003eP\u0026thinsp;=\u0026thinsp;0.001\u003c/em\u003e), while it was negatively correlated with PTH and Ca (\u003cem\u003eP\u0026thinsp;=\u0026thinsp;0.002\u003c/em\u003e, \u003cem\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/em\u003e). FIB was positively correlated with PLT (\u003cem\u003eP\u0026thinsp;=\u0026thinsp;0.002\u003c/em\u003e), PLT was negatively correlated with PTH (\u003cem\u003eP\u0026thinsp;=\u0026thinsp;0.005\u003c/em\u003e), and PTH was negatively correlated with P (\u003cem\u003eP\u0026thinsp;=\u0026thinsp;0.004\u003c/em\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eIn RA patients, CRP is positively correlated with ESR (), FIB (\u003cem\u003eP\u0026thinsp;=\u0026thinsp;0.001\u003c/em\u003e), and PLT (\u003cem\u003eP\u0026thinsp;=\u0026thinsp;0.009\u003c/em\u003e); ESR is positively correlated with FIB (\u003cem\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/em\u003e) and PLT (\u003cem\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/em\u003e), while negatively correlated with 25(OH)D (P\u0026thinsp;=\u0026thinsp;0.018), PTH (P\u0026thinsp;=\u0026thinsp;0.009), and Ca (\u003cem\u003eP\u0026thinsp;=\u0026thinsp;0.009\u003c/em\u003e); FIB is positively correlated with PLT (\u003cem\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/em\u003e) and negatively correlated with PTH (\u003cem\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/em\u003e); PLT is negatively correlated with 25(OH)D (\u003cem\u003eP\u0026thinsp;=\u0026thinsp;0.006\u003c/em\u003e) and PTH (\u003cem\u003eP\u0026thinsp;=\u0026thinsp;0.001\u003c/em\u003e). 25(OH)D is positively correlated with Ca (\u003cem\u003eP\u0026thinsp;=\u0026thinsp;0.041\u003c/em\u003e); PTH is positively correlated with Ca (\u003cem\u003eP\u0026thinsp;=\u0026thinsp;0.026\u003c/em\u003e) and negatively correlated with P (\u003cem\u003eP\u0026thinsp;=\u0026thinsp;0.021\u003c/em\u003e)(Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cb\u003e2.6 Logistic regression analysis of inflammatory indicators, bone metabolism indicators, and related ratios in patients with OA, GA, and RA.\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eAnalysis of Line AUC Values for OA, GA, and RA Patients\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMarkers\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAUC\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eConfidence lower limit\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eConfidence upper limit\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003eROC comparison test\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOA-GA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eESR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFIB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eESR/FIB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.61\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eESR/Ca\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMarkerscombination\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.94\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOA-RA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCRP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCRP/ESR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePTH/PLT\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eESR/Ca\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFIB/Ca\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.77\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMarkerscombination\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGA-RA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePTH\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFIB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFIB/PLT\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMarkerscombination\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThrough linear logistic stepwise regression, inflammatory indicators, bone metabolism indicators, and related ratios were further screened, resulting in the selection of ESR, FIB, ESR/FIB, ESR/Ca, CRP, CRP/ESR, PTH/PLT, ESR/CA, FIB/CA, PTH, FIB, FIB/PLT as disease discrimination factors. The area under the curve (AUC) was used for evaluation, and the results showed that FIB had the highest AUC value in distinguishing OA and GA metabolites (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). The AUC value of FIB in distinguishing OA and GA was 0.87 (95% CI: 0.82, 0.92), while the AUC value of the combined indicators was 0.89 (95% CI: 0.84, 0.94). There was no significant difference in the AUC values between FIB and the combined indicators (P\u0026thinsp;=\u0026thinsp;0.1960). The AUC value of the combined indicators for OA and RA was 0.84 (95% CI: 0.79, 0.88), and the AUC value of the combined indicators was significantly higher than that of individual indicators (\u003cem\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/em\u003e). The AUC value of FIB in distinguishing between GA and RA was 0.66 (95% CI: 0.59, 0.74); the AUC value of the combined indicators was 0.73 (95% CI: 0.66, 0.81), and the AUC value of the combined indicators was significantly higher than that of individual indicators (\u003cem\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/em\u003e).\u003c/p\u003e\u003c/div\u003e"},{"header":"3 Discussion","content":"\u003cp\u003eOA, GA, and RA are common inflammatory joint diseases in the rheumatology department. All three diseases involve varying degrees of inflammatory response and joint destruction during their course. The inflammatory markers studied in this article include CRP, ESR, FIB, and PLT. The inflammatory indicators include CRP, ESR, and PLT. CRP is a protein rapidly synthesized by liver cells when the body is infected or tissue is damaged, and it significantly increases during tissue injury, malignant tumors, and acute or chronic infections; ESR refers to the distance red blood cells settle in anticoagulated whole blood after one hour under certain conditions. Accelerated ESR can be seen in inflammatory diseases, tissue injury and necrosis, malignant tumors, etc. Related studies \u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e have found that serum CRP and ESR can serve as important risk factors for RA onset, and ESR is positively correlated with symptoms such as morning stiffness and joint swelling and pain in RA patients. CRP and ESR show a significant upward trend during RA disease activity, with CRP \u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e highly expressed in RA patients. PLT are anucleate cell fragments shed from megakaryocyte cytoplasm, playing an important role in coagulation, hemostasis, and thrombosis. Recent studies have found that besides hemostatic function, PLT also participate in innate immunity and inflammatory responses \u003csup\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e. FIB is a plasma protein mainly synthesized by the liver, which increases reactively during inflammation, stress, and trauma. Under physiological conditions, FIB participates in hemostasis, coagulation, vascular remodeling, wound healing, and tissue repair under the action of thrombin. Some studies have pointed out \u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e that FIB can serve as an independent factor for assessing disease activity in gout patients. Xue L \u003csup\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e and others found that FIB levels in RA patients are significantly higher than in healthy individuals, and high FIB levels are associated with the degree of joint inflammation and synovial destruction in RA patients. Research shows \u003csup\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e that plasma D-dimer and FIB levels in RA patients are related to the degree of joint destruction and disease activity. Routine clinical inflammatory markers CRP, ESR, and PLT are easily influenced by various factors and may only reflect inflammatory activity; all three have low specificity. The analysis of this study\u0026rsquo;s results suggests that FIB levels may be one of the effective and important indicators for differentiating OA, GA, and RA patients, with differences in disease levels among the three patient groups. This study found that compared to OA and RA patients, FIB levels are higher in GA patients, while FIB levels in OA patients are slightly lower than those in RA patients.\u003c/p\u003e\u003cp\u003eRecent studies have shown correlations among inflammatory markers. He M \u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/sup\u003e and others found that FIB is positively correlated with ESR and hypersensitive C-reactive protein (hs-CRP), and PLT is positively correlated with both ESR and hs-CRP, indicating that coagulation markers and inflammatory markers can influence each other in OA patients, with coagulation markers serving as important indicators of OA disease activity. Additionally, related research suggests a certain connection between the coagulation system and inflammatory response \u003csup\u003e[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e, with a complex regulatory mechanism existing among inflammation, anticoagulation, coagulation, and fibrinolysis systems; the hemostasis and coagulation processes are accompanied by inflammatory responses. This study found positive correlations among the inflammatory markers ESR, FIB, CRP, and PLT. Combined with correlation analysis, it is evident that ESR, FIB, CRP, and PLT have good correlations in differentiating OA, GA, and RA. Logistic regression analysis of the AUC values for the ESR/FIB ratio, CRP/ESR ratio, and FIB/PLT ratio indicates that these ratios may play important roles in distinguishing among OA, GA, and RA diseases.\u003c/p\u003e\u003cp\u003eBone metabolism markers are important indicators for understanding the dynamic interactions between osteoclasts and osteoblasts in the body. In this study, bone metabolism markers include 25(OH)D, Ca, P, and PTH, all of which reflect the body's bone metabolism level. 25(OH)D is the active form of vitamin D in the body, which promotes calcium absorption and maintains bone metabolism balance by regulating calcium and phosphorus metabolism levels \u003csup\u003e[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/sup\u003e. PTH is a polypeptide hormone secreted by the parathyroid glands, mainly involved in bone metabolism by regulating calcium and phosphorus metabolism levels, increasing blood calcium levels and decreasing blood phosphorus levels \u003csup\u003e[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/sup\u003e. In this study, there were statistically significant differences in PTH and Ca levels among the three patient groups. The OA group had higher PTH and Ca levels than the GA and RA groups. PTH and P showed a negative correlation in RA and OA patients, indicating that as PTH levels increase, P levels relatively decrease. In RA patients, PTH levels were positively correlated with Ca. Combined with the Logistic regression results, PTH can be used to distinguish between GA and RA patients, and when combined with other markers, it can better differentiate these two diseases. The AUC values of PTH combined with other markers indicate its ability to distinguish between OA and RA patients.\u003c/p\u003e\u003cp\u003eThere is a correlation between inflammatory markers and bone metabolism markers. Studies have found that increased inflammation levels in patients with rheumatic autoimmune arthritis \u003csup\u003e[\u003cspan additionalcitationids=\"CR25\" citationid=\"CR22\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e26\u003c/span\u003e]\u003c/sup\u003e can cause bone metabolism disorders and bone destruction. In this study, a negative correlation was observed between inflammatory markers and bone metabolism markers in the three patient groups. Combined with Logistic analysis, it was found that the ESR/Ca ratio, PTH/PLT ratio, and FIB/Ca ratio may play important roles in differentiating OA, GA, and RA diseases.\u003c/p\u003e\u003cp\u003eIn summary, this study found that FIB can serve as an important metabolic indicator to distinguish OA, GA, and RA diseases. FIB levels are higher in GA patients, slightly lower in RA patients compared to GA patients, and lower in OA patients. Additionally, FIB shows a positive correlation with ESR, CRP, and PLT. Furthermore, PTH levels can also be used to differentiate among OA, GA, and RA patients. There is a negative correlation between inflammatory markers and bone metabolism markers. FIB can satisfactorily distinguish between OA and GA, while combinations of indicators such as CRP, CRP/ESR, PTH/PLT, ESR/Ca, and FIB/Ca better differentiate OA and RA patients. At the same time, the combination of PTH, FIB, and FIB/PLT indicators better distinguishes GA and RA patients. The P/FIB ratio level in OA patients is higher than in GA and RA groups, with RA patients having a higher P/FIB ratio than GA patients. The FIB/Ca ratio level in GA patients is higher than in OA and RA groups, with RA patients having higher FIB/Ca levels than OA patients. Combined with Logistic regression results, it was found that FIB and related indicator combinations play an important role in distinguishing OA, GA, and RA diseases.\u003c/p\u003e\u003cp\u003eIt is thus concluded that FIB, the P/FIB ratio, and the FIB/Ca ratio show significant differences among OA, GA, and RA patients and can be used to differentiate these patients. Moreover, related indicator combinations may also be used to distinguish OA, GA, and RA patients.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eAUC \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Area under the curve\u003c/p\u003e\n\u003cp\u003eBMI \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Bodymass index\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCRP \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; C-reactive protein\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCa \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Calcium \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDBP \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Diastolic blood pressure\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eESR \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Sedimentation rate\u003c/p\u003e\n\u003cp\u003eFIB \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Fibrinogen\u003c/p\u003e\n\u003cp\u003eGA \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Gouty arthritis\u003c/p\u003e\n\u003cp\u003eOA \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Osteoarthritis\u003c/p\u003e\n\u003cp\u003ePTH \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Parathyroid hormone\u003c/p\u003e\n\u003cp\u003ePLT \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Platelet\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eP \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Phosphorus\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eRA \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Rheumatoid arthritis\u003c/p\u003e\n\u003cp\u003eSBP \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Systolic blood pressure\u003c/p\u003e\n\u003cp\u003ehs-CRP\u0026nbsp; \u0026nbsp; \u0026nbsp;C-reactive protein\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e25(OH)D \u0026nbsp; \u0026nbsp;25-hydroxyvitamin D\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eXW and ZL contributed to the conception and design. XW wrote the manuscript. YL, SL, and XW contributed to acquisition of data and data analysis. All authors contributed to the article and approved the submitted version.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by the Program of the National Natural Science Foundation of China (Grant No.82405366),\u0026nbsp;Guizhou Provincial Clinical Research Center for Traditional Chinese Medicine in Rheumatic and Immunological Diseases [Qiankehe Platform Talent (202222)].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data are sourced from The Second Affiliated Hospital of Guizhou University of Traditional Chinese Medicine. Due to the need for further data analysis and reuse by the data committee, other data analyses are being conducted. The data that support the findings of this study are available on request from the corresponding author XW on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Medical Ethics Committee of the Second Affiliated Hospital of Guizhou University of Traditional Chinese Medicine (LW20240718) and exempted from signing patient informed consent forms.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAbramoff B, Caldera FE. Osteoarthritis: Pathology, Diagnosis, and Treatment Options [J].Med Clin North Am. 2020;104(2):293-311.\u003c/li\u003e\n\u003cli\u003eAbramoff, Benjamin, Franklin E Caldera. \u0026ldquo;Osteoarthritis: Pathology, Diagnosis, and Treatment Options.\u0026rdquo; [J].The Medical clinics of North America vol. 104,2 (2020): 293-311. \u003c/li\u003e\n\u003cli\u003eDumusc A, So A. Advances in treatment of hyperuricemia and gout. Die Zukunft der Gichttherapie.Ther Umsch. 2024;81(5):168-171. \u003c/li\u003e\n\u003cli\u003eDu L, Zong Y, Li H, et al. Hyperuricemia and its related diseases: mechanisms and advances in therapy.Signal Transduct Target Ther. 2024;9(1):212. Published 2024 Aug 28. \u003c/li\u003e\n\u003cli\u003eD\u0026iacute;az-Gonz\u0026aacute;lez, Federico, Mar\u0026iacute;a V Hern\u0026aacute;ndez-Hern\u0026aacute;ndez. \u0026ldquo;Rheumatoid arthritis.\u0026rdquo; \u0026ldquo;Artritis reumatoide.\u0026rdquo; [J]. Medicina clinica vol. 161,12 (2023): 533-542.\u003c/li\u003e\n\u003cli\u003eJang S,Kwon EJ, Lee JJ. Rheumatoid Arthritis: Pathogenic Roles of Diverse Immune Cells [J].Int J Mol Sci. 2022;23(2):905. Published 2022 Jan 14.\u003c/li\u003e\n\u003cli\u003eZhang J. Clinical Analysis of 22 Misdiagnosed Cases of Rheumatoid Arthritis [J]. Jiangxi Medical Journal. 2021;56(09):1425 - 1427.\u003c/li\u003e\n\u003cli\u003eZhang J, Zou M, Chi J, et al. Value of Joint Fluid and Blood-related Indicators in the Diagnosis of Gouty Arthritis and Rheumatoid Arthritis [J]. West China Medical Journal. 2016;31(08):1376-1379.\u003c/li\u003e\n\u003cli\u003eZhang W, Doherty M, Peat G, et al. EULAR evidence-based recommendations for the diagnosis of knee osteoarthritis [J]. Ann Rheum Dis. 2010;69(3):483-489.\u003c/li\u003e\n\u003cli\u003eNeogi T, Jansen TLTA, Dalbeth N, et al. 2015 Gout classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative [J]. Ann Rheum Dis.2015;74(10):1789-1798. \u003c/li\u003e\n\u003cli\u003eSingh JA, Saag KG, Bridges SL, et al. 2015 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis. Arthritis Rheumatol Hoboken NJ [J].2016;68(1):1-26.\u003c/li\u003e\n\u003cli\u003eOrr CK, Najm A, Young F, et al. The Utility and Limitations of CRP, ESR and DAS28-CRP in Appraising Disease Activity in Rheumatoid Arthritis. Front Med (Lausanne). 2018 Aug 3;5:185.\u003c/li\u003e\n\u003cli\u003eKilcher G, Hummel N, Didden EM, et al.Rheumatoid arthritis patients treated in trial and real world settings: comparison of randomized trials with registries. Rheumatology (Oxford). 2018 Feb 1;57(2):354-369. \u003c/li\u003e\n\u003cli\u003eMaouia A, Rebetz J, Kapur R, et al. The Immune Nature of Platelets Revisited. Transfus Med Rev. 2020 Oct;34(4):209-220. \u003c/li\u003e\n\u003cli\u003eChen S, Huang X, Huang Y, et al. Role of plasma fibrinogen in assessing disease activity of patients with gout. Clin Chim Acta. 2020 Nov;510:483-487. \u003c/li\u003e\n\u003cli\u003eXue L, Tao L, Li X, Wang Y, et al. D-dimer, and fibrin degradation product as biomarkers of rheumatoid arthritis. Sci Rep. 2021 Aug 19;11(1):16903. \u003c/li\u003e\n\u003cli\u003eQiang F, Xu H, Sheng J. Relationship between plasma fibrinogen degradation products(FDP) and D-dimer levels and disease activity in rheumatoid arthritis: A STROBE compliant article. Medicine (Baltimore). 2022 Sep 9;101(36):e30455.\u003c/li\u003e\n\u003cli\u003eHe M, Liu J, Xin L, et al. Changes of coagulation indexes and correlation analysis betweenthem,immunity indexes,inflammation indexes and lipid metabolismindexes in 717 cases of patients with osteoarthritis [J].Journal of Gansu University of Chinese Medicine. 2021;38(03):68-73.\u003c/li\u003e\n\u003cli\u003eLevi M, van der Poll T. Inflammation and coagulation. Crit Care Med. 2010 Feb;38(2 Suppl):S26-34. \u003c/li\u003e\n\u003cli\u003eS\u0026icirc;rbe C, Rednic S, Grama A, et al. An Update on the Effects of Vitamin D on the Immune System and Autoimmune Diseases. Int J Mol Sci. 2022 Aug 29;23(17):9784. \u003c/li\u003e\n\u003cli\u003eGoltzman D, Mannstadt M, Marcocci C. Physiology of the Calcium-Parathyroid Hormone-Vitamin D Axis. Front Horm Res. 2018;50:1-13. \u003c/li\u003e\n\u003cli\u003eMaeda K, Yoshida K, Nishizawa T, et al. Inflammation and Bone Metabolism in Rheumatoid Arthritis: Molecular Mechanisms of Joint Destruction and Pharmacological Treatments. Int J Mol Sci. 2022 Mar 6;23(5):2871. \u003c/li\u003e\n\u003cli\u003eKomatsu N, Takayanagi H. Mechanisms of joint destruction in rheumatoid arthritis - immune cell-fibroblast-bone interactions. Nat Rev Rheumatol. 2022 Jul;18(7):415-429. \u003c/li\u003e\n\u003cli\u003eDu X, Liu ZY, Tao XX, et al. Research Progress on the Pathogenesis of Knee Osteoarthritis. Orthop Surg. 2023 Sep;15(9):2213-2224. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"osteoarthritis, gouty arthritis, rheumatoid arthritis, inflammatory markers, bone metabolism markers","lastPublishedDoi":"10.21203/rs.3.rs-7193571/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7193571/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjectives\u003c/h2\u003e\u003cp\u003eTo investigate the differences in the expression of inflammatory and bone metabolism markers in patients with osteoarthritis, gouty arthritis and rheumatoid arthritis, and to elucidate the correlation between the markers of the three diseases.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003e373 patients were retrospectively analyzed, including 138 patients with osteoarthritis(OA), 72 patients with gouty arthritis(GA) and 163 patients with rheumatoid arthritis༈RA༉. Blood indices included inflammatory indices and bone metabolism indices. In this study, we firstly screened the three kinds of differential markers by differential analysis between diseases, secondly used correlation analysis to determine the correlation between markers, and finally performed binary logistic regression analysis.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003efibrinogen(FIB) can be used as an important marker to differentiate OA, GA and RA.The level of FIB was higher in GA, slightly lower in RA than in GA, and lower in OA, and there was a positive correlation between FIB and erythrocyte sedimentation rate(ESR).The area under the curve(AUC) of FIB in OA and GA patients was 0.87 (95% CI: 0.82, 0.92), the AUC value of ESR/Ca in OA and RA was 0.79 (95% CI: 0.74, 0.84), and the AUC value of the combination of disease indexes was 0.84 (95% CI: 0.79, 0.88).The AUC value of FIB in GA and RA and the FIB/ PLT had an AUC value of 0.66 (95% CI: 0.59, 0.74) and disease marker combination AUC value of 0.73 (95% CI: 0.66, 0.81).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eFIB was positively correlated with c-reactive protein(CRP),ESR, and platelet(PLT) in OA, GA, and RA patients, and FIB, P/FIB ratio, and FIB/Ca ratio were significantly different in OA, GA, and RA patients. PLT, ESR/CA, FIB/CA, PTH,\u003ca class=\"FNLink\" href=\"#Fn1\" id=\"#FNLinkFn1\"\u003e\u003c/a\u003e FIB, FIB/PLT marker combinations may also be used to differentiate OA, GA, and RA patients.\u003c/p\u003e","manuscriptTitle":"Differential expression and correlation of inflammatory markers and bone metabolism markers in osteoarthritis, gouty arthritis and rheumatoid arthritis:a retrospective cohort study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-31 16:17:19","doi":"10.21203/rs.3.rs-7193571/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"8d230408-5fbb-4dc6-82af-200bf3373e78","owner":[],"postedDate":"July 31st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-09-05T06:09:01+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-31 16:17:19","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7193571","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7193571","identity":"rs-7193571","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}