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Kıkırdak Dönüşümünün İzlenmesi: Erken Romatoid Artrit İlerlemesi Ve Anti-Tnf Tedavi Yanıtının Biyomarkeri Olarak İdrar Ctx-Iı

Yıl 2025, Cilt: 6 Sayı: 2, 173 - 184, 28.07.2025

Bora Uzuner , Sertaç Ketenci , Ayhan Bilgici , Ender Salbaş , Abdülkerim Bedir

Öz

Giriş: Bu çalışma, romatoid artrit (RA) hastalarında idrar C-telopeptit tip II kollajen (CTX-II) düzeylerinin kıkırdak döngüsü, hastalık aktivitesi ve anti-TNF tedavi yanıtı açısından bir biyobelirteç olarak rolünü, özellikle erken hastalıkta değerlendirmeyi amaçladı.

Yöntemler: Haziran - Ekim 2010 tarihleri arasında gerçekleştirilen prospektif kohort çalışmasında, anti-TNF tedaviye (adalimumab, etanercept veya infliksimab) yeni başlayan 39 RA hastası ve yaş-cinsiyet uyumlu 36 sağlıklı kontrol dahil edildi. Başlangıç ve 3. ay değerlendirmelerinde idrar CTX-II (kreatinine göre düzeltilmiş), 28 eklem Hastalık Aktivite Skoru (DAS28), Sağlık Değerlendirme Anketi (HAQ) ve van der Heijde modifiye Toplam Sharp Skoru (mTSS) ölçüldü. CTX-II ile hastalık aktivitesi ve radyografik hasar arasındaki ilişkiler Spearman rank korelasyonu ile analiz edildi. CTX-II değişiklikleri Wilcoxon işaretli sıralar testi ile değerlendirildi; erken (<3 yıl) ve yerleşik RA alt grup analizleri yapıldı.

Bulgular: Başlangıçta RA hastalarında idrar CTX-II düzeyleri kontrollere göre anlamlı derecede yüksekti (447.8 ± 359.3 vs. 233.8 ± 122.4 ng/mmol, p<0.005). CTX-II, DAS28 (ρ=0.609, p<0.001), HAQ (ρ=0.493, p=0.001) ve eklem sayıları ile pozitif korelasyon gösterdi; romatoid faktör (RF) pozitif hastalarda iki kat yüksekti (557.0 ± 395.0 vs. 252.8 ± 159.6 ng/mmol, p=0.018). Üç ay sonra erken RA hastaları (n=11) %45’lik anlamlı CTX-II azalması gösterirken (p=0.016), yerleşik RA hastalarında (n=20) değişiklik olmadı (p=0.421). Remisyona ulaşan hastalar (DAS28 <2.6, n=12) kontrollere benzer CTX-II düzeylerine sahipti (p=0.005). Yüksek başlangıç CTX-II’si olanlar (≥479 ng/mmol, n=8) %46 azalma gösterdi (p=0.017).

Sonuç: İdrar CTX-II, özellikle erken RA’da kıkırdak döngüsü ve anti-TNF yanıtını izleyen dinamik bir biyobelirteçtir. RF pozitifliği ve remisyon ile ilişkisi, kişiselleştirilmiş RA yönetiminde potansiyelini vurgular. Klinik kullanım için standardize kesim değerlerinin validasyonu gereklidir.

Anahtar Kelimeler

idrar CTX-II anti-TNF tedavi kıkırdak turnover erken RA BİYOBELİRTEÇ ROMATOİD ARTRİT

Proje Numarası

PYO.TIP.1904.10.012

Kaynakça

  • Johnson TM, Mikuls TR, England BR. Clinical Features of Rheumatoid Arthritis (Chapter 72). In: Firestein GS, McInnes IB, Koretzky G, Mikuls T, Neogi T, O'Dell JR, editors. Firestein & Kelley’s Textbook of Rheumatology. 2. 12 ed. Philadelphia: Elsevier; 2024. p. 1224-46.
  • Chauhan K, Jandu JS, Brent LH, Al-Dhahir MA. Rheumatoid Arthritis. StatPearls. Treasure Island (FL)2025.
  • Silvagni E, Zandonella Callegher S, Mauric E, Chiricolo S, Schreiber N, Tullio A, et al. Musculoskeletal ultrasound for treating rheumatoid arthritis to target-a systematic literature review. Rheumatology (Oxford). 2022;61(12):4590-602.
  • Salaffi F, Carotti M, Di Carlo M, Ceccarelli L, Farah S, Poliseno AC, et al. Magnetic Resonance Imaging (MRI)-Based Semi-Quantitative Methods for Rheumatoid Arthritis: From Scoring to Measurement. J Clin Med. 2024;13(14).
  • Han P, Liu X, He J, Han L, Li J. Overview of mechanisms and novel therapies on rheumatoid arthritis from a cellular perspective. Front Immunol. 2024;15:1461756.
  • Markovic M, Campochiaro C, Glisic B, Petronijevic M, Ristic G, Stanojevic I, et al. Association of circulating levels of anti-CarP antibodies with disease activity, disability and radiological damage in rheumatoid arthritis patients: an open-label, observational study. Sci Rep. 2025;15(1):18325.
  • Tanaka Y, Atsumi T, Aletaha D, Schulze-Koops H, Fukada H, Watson C, et al. The Uncoupling of Disease Activity from Joint Structural Progression in Patients with Rheumatoid Arthritis Treated with Filgotinib. Rheumatol Ther. 2025;12(1):53-66.
  • Smolinska V, Klimova D, Danisovic L, Harsanyi S. Synovial Fluid Markers and Extracellular Vesicles in Rheumatoid Arthritis. Medicina (Kaunas). 2024;60(12).
  • England BROd, James R. . Treatment of Rheumatoid Arthritis (Chapter 73). In: Firestein GS, McInnes IB, Koretzky G, Mikuls T, Neogi T, O'Dell JR, editors. Firestein & Kelley’s Textbook of Rheumatology. 2. 12 ed. Philadelphia: Elsevier; 2024. p. 1247-72.
  • Arnett FC, Edworthy SM, Bloch DA, McShane DJ, Fries JF, Cooper NS, et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum. 1988;31(3):315-24.
  • van Riel PL, Renskers L. The Disease Activity Score (DAS) and the Disease Activity Score using 28 joint counts (DAS28) in the management of rheumatoid arthritis. Clin Exp Rheumatol. 2016;34(5 Suppl 101):S40-S4.
  • Fries JF, Spitz P, Kraines RG, Holman HR. Measurement of patient outcome in arthritis. Arthritis Rheum. 1980;23(2):137-45.
  • van der Heijde D. How to read radiographs according to the Sharp/van der Heijde method. J Rheumatol. 2000;27(1):261-3.
  • Garnero P, Landewe R, Boers M, Verhoeven A, Van Der Linden S, Christgau S, et al. Association of baseline levels of markers of bone and cartilage degradation with long-term progression of joint damage in patients with early rheumatoid arthritis: the COBRA study. Arthritis Rheum. 2002;46(11):2847-56.
  • Meulenbelt I, Kloppenburg M, Kroon HM, Houwing-Duistermaat JJ, Garnero P, Hellio Le Graverand MP, et al. Urinary CTX-II levels are associated with radiographic subtypes of osteoarthritis in hip, knee, hand, and facet joints in subject with familial osteoarthritis at multiple sites: the GARP study. Ann Rheum Dis. 2006;65(3):360-5.
  • Garnero P, Gineyts E, Christgau S, Finck B, Delmas PD. Association of baseline levels of urinary glucosyl-galactosyl-pyridinoline and type II collagen C-telopeptide with progression of joint destruction in patients with early rheumatoid arthritis. Arthritis Rheum. 2002;46(1):21-30.
  • Strand V. Summary of Research: Effects of Adalimumab-adbm Versus Adalimumab Reference Product on Patient-Reported Outcomes in Rheumatoid Arthritis: Results from VOLTAIRE-RA. Rheumatol Ther. 2024;11(5):1081-4.
  • Yu CY, Lee HS, Joo YB, Cho SK, Choi CB, Sung YK, et al. Transcriptomic network analysis reveals key drivers of response to anti-TNF biologics in patients with rheumatoid arthritis. Rheumatology (Oxford). 2024;63(5):1422-31.
  • Di Matteo A, Bathon JM, Emery P. Rheumatoid arthritis. Lancet. 2023;402(10416):2019-33.
  • Kopec-Medrek M, Kucharz EJ. Fibulin-3 and other cartilage metabolism biomarkers in relationship to calprotectin (MRP8/14) and disease activity in rheumatoid arthritis patients treated with anti-TNF therapy. Adv Clin Exp Med. 2018;27(3):383-9.
  • Port H, Hausgaard CM, He Y, Maksymowych WP, Wichuk S, Sinkeviciute D, et al. A novel biomarker of MMP-cleaved cartilage intermediate layer protein-1 is elevated in patients with rheumatoid arthritis, ankylosing spondylitis and osteoarthritis. Sci Rep. 2023;13(1):21717.
  • Aletaha D, Alasti F, Smolen JS. Rheumatoid factor, not antibodies against citrullinated proteins, is associated with baseline disease activity in rheumatoid arthritis clinical trials. Arthritis Res Ther. 2015;17(1):229.
  • Hussein R, Aboukhamis I. The association of serum RANKL levels with disease activity and hematological parameters in Syrian patients with rheumatoid arthritis. Biochem Biophys Rep. 2022;32:101373.
  • Chen N, Diao CY, Huang X, Tan WX, Chen YB, Qian XY, et al. RhoA Promotes Synovial Proliferation and Bone Erosion in Rheumatoid Arthritis through Wnt/PCP Pathway. Mediators Inflamm. 2023;2023:5057009.
  • van Tuyl LH, Voskuyl AE, Boers M, Geusens P, Landewe RB, Dijkmans BA, et al. Baseline RANKL:OPG ratio and markers of bone and cartilage degradation predict annual radiological progression over 11 years in rheumatoid arthritis. Ann Rheum Dis. 2010;69(9):1623-8.
  • Szeremeta A, Jura-Poltorak A, Zon-Giebel A, Olczyk K, Komosinska-Vassev K. Effects of Etanercept and Adalimumab on Serum Levels of Cartilage Remodeling Markers in Women with Rheumatoid Arthritis. J Clin Med. 2023;12(16).
  • Sahin D, Di Matteo A, Emery P. Biomarkers in the diagnosis, prognosis and management of rheumatoid arthritis: A comprehensive review. Ann Clin Biochem. 2025;62(1):3-21.
  • Cho A, Ahn J, Kim A, Lee YJ, Song YW, Tanaka Y, et al. A multi-biomarker panel for predicting Tocilizumab response in Rheumatoid arthritis patients. Transl Res. 2024;273:23-31.
  • Drobinski PJ, Bay-Jensen AC, Karsdal MA, Sardar S, Siebuhr AS. Connective tissue remodelling is differently modulated by tocilizumab versus methotrexate monotherapy in patients with early rheumatoid arthritis: the AMBITION study. Arthritis Res Ther. 2021;23(1):13.
  • Plasencia-Rodriguez C, Martinez-Feito A, Novella-Navarro M, Perez De Diego R, Bonilla G, Gehin JE, et al. Influence of rheumatoid factor levels and TNF inhibitor structure on secondary nonresponse in rheumatoid arthritis patients. Front Med (Lausanne). 2024;11:1461396.
  • Gerriets V, Goyal A, Khaddour K. Tumor Necrosis Factor Inhibitors. StatPearls. Treasure Island (FL)2025.
  • Neto M, Mendes B, Albuquerque F, da Silva JAP. Novel biomarkers in RA: Implication for diagnosis, prognosis, and personalised treatment. Best Pract Res Clin Rheumatol. 2025;39(1):102021.

Tracking Cartilage Turnover: Urinary CTX-II as a Biomarker for Early Rheumatoid Arthritis Progression and Anti-TNF Therapy Response

Yıl 2025, Cilt: 6 Sayı: 2, 173 - 184, 28.07.2025

Bora Uzuner , Sertaç Ketenci , Ayhan Bilgici , Ender Salbaş , Abdülkerim Bedir

Öz

Introduction: This study aimed to evaluate urinary C-telopeptide of type II collagen (CTX-II) as a biomarker of cartilage turnover, disease activity, and anti-TNF therapy response in rheumatoid arthritis (RA), with a focus on early disease.

Methods: In a prospective cohort study (June–October 2010), 39 RA patients initiating anti-TNF therapy (adalimumab, etanercept, or infliximab) and 36 age- and sex-matched healthy controls were enrolled. Baseline and 3-month assessments included urinary CTX-II (corrected for creatinine), Disease Activity Score in 28 joints (DAS28), Health Assessment Questionnaire (HAQ), and van der Heijde modified Total Sharp Score (mTSS). Correlations between CTX-II and disease activity or radiographic damage were analyzed using Spearman’s rank correlation. Changes in CTX-II were assessed with the Wilcoxon signed-rank test, and subgroup analyses compared early (<3 years) versus established RA.

Results: At baseline, RA patients had significantly higher urinary CTX-II levels than controls (447.8 ± 359.3 vs. 233.8 ± 122.4 ng/mmol, p<0.005). CTX-II correlated positively with DAS28 (ρ=0.609, p<0.001), HAQ (ρ=0.493, p=0.001), and joint counts, and was twofold higher in RF-positive patients (557.0 ± 395.0 vs. 252.8 ± 159.6 ng/mmol, p=0.018). After 3 months, early RA patients (n=11) showed a significant 45% reduction in CTX-II (p=0.016), while established RA patients (n=20) showed no change (p=0.421). Patients in remission (DAS28 <2.6, n=12) had CTX-II levels comparable to controls (p=0.005). High baseline CTX-II (≥479 ng/mmol, n=8) predicted a 46% reduction post-therapy (p=0.017).

Conclusion: Urinary CTX-II is a dynamic biomarker of cartilage turnover and anti-TNF response, particularly in early RA. Its association with RF positivity and remission suggests a role in personalized RA management. Larger studies are needed to validate standardized cut-offs for clinical use.

Anahtar Kelimeler

rheumatoid arthritis urinary CTX-II anti-TNF therapy cartilage turnover early RA rheumatoid factor biomarker

Etik Beyan

ETİK BEYAN FORMU ….01./…06../2025… Bu çalışmanın, özgün bir çalışma olduğunu; çalışmanın hazırlık, veri toplama, analiz ve bilgilerin sunumu olmak üzere tüm aşamalarından bilimsel etik ilke ve kurallarına uygun davrandığımı; bu çalışma kapsamında elde edilmeyen tüm veri ve bilgiler için kaynak gösterdiğimi ve bu kaynaklara kaynakçada yer verdiğimi; kullanılan verilerde herhangi bir değişiklik yapmadığımı, çalışmanın Committee on Publication Ethics (COPE)' in tüm şartlarını ve koşullarını kabul ederek etik görev ve sorumluluklara riayet ettiğimi beyan ederim. Herhangi bir zamanda, çalışmayla ilgili yaptığım bu beyana aykırı bir durumun saptanması durumunda, ortaya çıkacak tüm ahlaki ve hukuki sonuçlara razı olduğumu bildiririm. (Islak İmza) Sorumlu Yazar Adı ve Soyadı 01 06 25 Dr. Bora UZUNER

Destekleyen Kurum

yok

Proje Numarası

PYO.TIP.1904.10.012

Kaynakça

  • Johnson TM, Mikuls TR, England BR. Clinical Features of Rheumatoid Arthritis (Chapter 72). In: Firestein GS, McInnes IB, Koretzky G, Mikuls T, Neogi T, O'Dell JR, editors. Firestein & Kelley’s Textbook of Rheumatology. 2. 12 ed. Philadelphia: Elsevier; 2024. p. 1224-46.
  • Chauhan K, Jandu JS, Brent LH, Al-Dhahir MA. Rheumatoid Arthritis. StatPearls. Treasure Island (FL)2025.
  • Silvagni E, Zandonella Callegher S, Mauric E, Chiricolo S, Schreiber N, Tullio A, et al. Musculoskeletal ultrasound for treating rheumatoid arthritis to target-a systematic literature review. Rheumatology (Oxford). 2022;61(12):4590-602.
  • Salaffi F, Carotti M, Di Carlo M, Ceccarelli L, Farah S, Poliseno AC, et al. Magnetic Resonance Imaging (MRI)-Based Semi-Quantitative Methods for Rheumatoid Arthritis: From Scoring to Measurement. J Clin Med. 2024;13(14).
  • Han P, Liu X, He J, Han L, Li J. Overview of mechanisms and novel therapies on rheumatoid arthritis from a cellular perspective. Front Immunol. 2024;15:1461756.
  • Markovic M, Campochiaro C, Glisic B, Petronijevic M, Ristic G, Stanojevic I, et al. Association of circulating levels of anti-CarP antibodies with disease activity, disability and radiological damage in rheumatoid arthritis patients: an open-label, observational study. Sci Rep. 2025;15(1):18325.
  • Tanaka Y, Atsumi T, Aletaha D, Schulze-Koops H, Fukada H, Watson C, et al. The Uncoupling of Disease Activity from Joint Structural Progression in Patients with Rheumatoid Arthritis Treated with Filgotinib. Rheumatol Ther. 2025;12(1):53-66.
  • Smolinska V, Klimova D, Danisovic L, Harsanyi S. Synovial Fluid Markers and Extracellular Vesicles in Rheumatoid Arthritis. Medicina (Kaunas). 2024;60(12).
  • England BROd, James R. . Treatment of Rheumatoid Arthritis (Chapter 73). In: Firestein GS, McInnes IB, Koretzky G, Mikuls T, Neogi T, O'Dell JR, editors. Firestein & Kelley’s Textbook of Rheumatology. 2. 12 ed. Philadelphia: Elsevier; 2024. p. 1247-72.
  • Arnett FC, Edworthy SM, Bloch DA, McShane DJ, Fries JF, Cooper NS, et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum. 1988;31(3):315-24.
  • van Riel PL, Renskers L. The Disease Activity Score (DAS) and the Disease Activity Score using 28 joint counts (DAS28) in the management of rheumatoid arthritis. Clin Exp Rheumatol. 2016;34(5 Suppl 101):S40-S4.
  • Fries JF, Spitz P, Kraines RG, Holman HR. Measurement of patient outcome in arthritis. Arthritis Rheum. 1980;23(2):137-45.
  • van der Heijde D. How to read radiographs according to the Sharp/van der Heijde method. J Rheumatol. 2000;27(1):261-3.
  • Garnero P, Landewe R, Boers M, Verhoeven A, Van Der Linden S, Christgau S, et al. Association of baseline levels of markers of bone and cartilage degradation with long-term progression of joint damage in patients with early rheumatoid arthritis: the COBRA study. Arthritis Rheum. 2002;46(11):2847-56.
  • Meulenbelt I, Kloppenburg M, Kroon HM, Houwing-Duistermaat JJ, Garnero P, Hellio Le Graverand MP, et al. Urinary CTX-II levels are associated with radiographic subtypes of osteoarthritis in hip, knee, hand, and facet joints in subject with familial osteoarthritis at multiple sites: the GARP study. Ann Rheum Dis. 2006;65(3):360-5.
  • Garnero P, Gineyts E, Christgau S, Finck B, Delmas PD. Association of baseline levels of urinary glucosyl-galactosyl-pyridinoline and type II collagen C-telopeptide with progression of joint destruction in patients with early rheumatoid arthritis. Arthritis Rheum. 2002;46(1):21-30.
  • Strand V. Summary of Research: Effects of Adalimumab-adbm Versus Adalimumab Reference Product on Patient-Reported Outcomes in Rheumatoid Arthritis: Results from VOLTAIRE-RA. Rheumatol Ther. 2024;11(5):1081-4.
  • Yu CY, Lee HS, Joo YB, Cho SK, Choi CB, Sung YK, et al. Transcriptomic network analysis reveals key drivers of response to anti-TNF biologics in patients with rheumatoid arthritis. Rheumatology (Oxford). 2024;63(5):1422-31.
  • Di Matteo A, Bathon JM, Emery P. Rheumatoid arthritis. Lancet. 2023;402(10416):2019-33.
  • Kopec-Medrek M, Kucharz EJ. Fibulin-3 and other cartilage metabolism biomarkers in relationship to calprotectin (MRP8/14) and disease activity in rheumatoid arthritis patients treated with anti-TNF therapy. Adv Clin Exp Med. 2018;27(3):383-9.
  • Port H, Hausgaard CM, He Y, Maksymowych WP, Wichuk S, Sinkeviciute D, et al. A novel biomarker of MMP-cleaved cartilage intermediate layer protein-1 is elevated in patients with rheumatoid arthritis, ankylosing spondylitis and osteoarthritis. Sci Rep. 2023;13(1):21717.
  • Aletaha D, Alasti F, Smolen JS. Rheumatoid factor, not antibodies against citrullinated proteins, is associated with baseline disease activity in rheumatoid arthritis clinical trials. Arthritis Res Ther. 2015;17(1):229.
  • Hussein R, Aboukhamis I. The association of serum RANKL levels with disease activity and hematological parameters in Syrian patients with rheumatoid arthritis. Biochem Biophys Rep. 2022;32:101373.
  • Chen N, Diao CY, Huang X, Tan WX, Chen YB, Qian XY, et al. RhoA Promotes Synovial Proliferation and Bone Erosion in Rheumatoid Arthritis through Wnt/PCP Pathway. Mediators Inflamm. 2023;2023:5057009.
  • van Tuyl LH, Voskuyl AE, Boers M, Geusens P, Landewe RB, Dijkmans BA, et al. Baseline RANKL:OPG ratio and markers of bone and cartilage degradation predict annual radiological progression over 11 years in rheumatoid arthritis. Ann Rheum Dis. 2010;69(9):1623-8.
  • Szeremeta A, Jura-Poltorak A, Zon-Giebel A, Olczyk K, Komosinska-Vassev K. Effects of Etanercept and Adalimumab on Serum Levels of Cartilage Remodeling Markers in Women with Rheumatoid Arthritis. J Clin Med. 2023;12(16).
  • Sahin D, Di Matteo A, Emery P. Biomarkers in the diagnosis, prognosis and management of rheumatoid arthritis: A comprehensive review. Ann Clin Biochem. 2025;62(1):3-21.
  • Cho A, Ahn J, Kim A, Lee YJ, Song YW, Tanaka Y, et al. A multi-biomarker panel for predicting Tocilizumab response in Rheumatoid arthritis patients. Transl Res. 2024;273:23-31.
  • Drobinski PJ, Bay-Jensen AC, Karsdal MA, Sardar S, Siebuhr AS. Connective tissue remodelling is differently modulated by tocilizumab versus methotrexate monotherapy in patients with early rheumatoid arthritis: the AMBITION study. Arthritis Res Ther. 2021;23(1):13.
  • Plasencia-Rodriguez C, Martinez-Feito A, Novella-Navarro M, Perez De Diego R, Bonilla G, Gehin JE, et al. Influence of rheumatoid factor levels and TNF inhibitor structure on secondary nonresponse in rheumatoid arthritis patients. Front Med (Lausanne). 2024;11:1461396.
  • Gerriets V, Goyal A, Khaddour K. Tumor Necrosis Factor Inhibitors. StatPearls. Treasure Island (FL)2025.
  • Neto M, Mendes B, Albuquerque F, da Silva JAP. Novel biomarkers in RA: Implication for diagnosis, prognosis, and personalised treatment. Best Pract Res Clin Rheumatol. 2025;39(1):102021.
Toplam 32 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Ağrı, Romatoloji ve Artrit, Klinik Tıp Bilimleri (Diğer)
Bölüm Araştırma Makaleleri
Yazarlar

Bora Uzuner 0000-0001-9498-0289

Sertaç Ketenci 0000-0002-2950-8778

Ayhan Bilgici 0000-0002-7854-314X

Ender Salbaş 0000-0001-7460-2889

Abdülkerim Bedir 0000-0002-7466-952X

Proje Numarası PYO.TIP.1904.10.012
Yayımlanma Tarihi 28 Temmuz 2025
Gönderilme Tarihi 1 Haziran 2025
Kabul Tarihi 16 Temmuz 2025
Yayımlandığı Sayı Yıl 2025 Cilt: 6 Sayı: 2

Kaynak Göster

APA Uzuner, B., Ketenci, S., Bilgici, A., Salbaş, E., vd. (2025). Tracking Cartilage Turnover: Urinary CTX-II as a Biomarker for Early Rheumatoid Arthritis Progression and Anti-TNF Therapy Response. Eskisehir Medical Journal, 6(2), 173-184.
AMA Uzuner B, Ketenci S, Bilgici A, Salbaş E, Bedir A. Tracking Cartilage Turnover: Urinary CTX-II as a Biomarker for Early Rheumatoid Arthritis Progression and Anti-TNF Therapy Response. Eskisehir Med J. Temmuz 2025;6(2):173-184.
Chicago Uzuner, Bora, Sertaç Ketenci, Ayhan Bilgici, Ender Salbaş, ve Abdülkerim Bedir. “Tracking Cartilage Turnover: Urinary CTX-II As a Biomarker for Early Rheumatoid Arthritis Progression and Anti-TNF Therapy Response”. Eskisehir Medical Journal 6, sy. 2 (Temmuz 2025): 173-84.
EndNote Uzuner B, Ketenci S, Bilgici A, Salbaş E, Bedir A (01 Temmuz 2025) Tracking Cartilage Turnover: Urinary CTX-II as a Biomarker for Early Rheumatoid Arthritis Progression and Anti-TNF Therapy Response. Eskisehir Medical Journal 6 2 173–184.
IEEE B. Uzuner, S. Ketenci, A. Bilgici, E. Salbaş, ve A. Bedir, “Tracking Cartilage Turnover: Urinary CTX-II as a Biomarker for Early Rheumatoid Arthritis Progression and Anti-TNF Therapy Response”, Eskisehir Med J, c. 6, sy. 2, ss. 173–184, 2025.
ISNAD Uzuner, Bora vd. “Tracking Cartilage Turnover: Urinary CTX-II As a Biomarker for Early Rheumatoid Arthritis Progression and Anti-TNF Therapy Response”. Eskisehir Medical Journal 6/2 (Temmuz 2025), 173-184.
JAMA Uzuner B, Ketenci S, Bilgici A, Salbaş E, Bedir A. Tracking Cartilage Turnover: Urinary CTX-II as a Biomarker for Early Rheumatoid Arthritis Progression and Anti-TNF Therapy Response. Eskisehir Med J. 2025;6:173–184.
MLA Uzuner, Bora vd. “Tracking Cartilage Turnover: Urinary CTX-II As a Biomarker for Early Rheumatoid Arthritis Progression and Anti-TNF Therapy Response”. Eskisehir Medical Journal, c. 6, sy. 2, 2025, ss. 173-84.
Vancouver Uzuner B, Ketenci S, Bilgici A, Salbaş E, Bedir A. Tracking Cartilage Turnover: Urinary CTX-II as a Biomarker for Early Rheumatoid Arthritis Progression and Anti-TNF Therapy Response. Eskisehir Med J. 2025;6(2):173-84.
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