Association between the C-Reactive protein–triglyceride–glucose index and osteoarthritis risk in prediabetic mellitus adults

The C-reactive protein–triglyceride–glucose index (CTI) has been identified as a potential new biomarker for insulin resistance and inflammation. However, the association between CTI and osteoarthritis (OA) risk in prediabetic (Pre-DM) individuals from different populations remains unclear. This population-based cohort study included 3043 participants from the China Health and Retirement Longitudinal Study across Waves 1 to 5. The primary endpoint was the incidence of OA events. The associations between the CTI and incident OA incidence were evaluated by competing risk models and Cox regression models, with restricted cubic splines applied to investigate potential nonlinear relationships. To ensure the robustness of the findings, subgroup analyses, multiple imputation, and propensity score methods were also applied. During the 9-year follow-up, 946 (31.09%) participants developed OA. The highest OA risk was observed in the highest CTI quartile (Q4) (HR, 1.376; 95% CI, 1.12, 1.692) in Model 3. A nonlinear relationship between the CTI and OA risk was identified ( P for nonlinearity = .012). Subgroup analysis revealed that individuals with a body mass index <24 years and those with a body mass index between 24 and 28 years were more sensitive to the adverse effects of the CTI on OA risk ( P for interaction = .012). Furthermore, the association between elevated CTI and OA risk remained consistent across various sensitivity analyses. The CTI can serve as an independent risk marker for predicting the onset of incident OA in middle-aged and older individuals with Pre-DM. Addressing insulin resistance and inflammation may play a crucial role in enhancing primary prevention strategies for OA.