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A systematic review of the relationship between subchondral bone features, pain and structural pathology in peripheral joint osteoarthritis.

Barr AJ, Campbell TM, Hopkinson D, Kingsbury SR, Bowes MA, Conaghan PG - Arthritis Res. Ther. (2015)

Bottom Line: BMLs and bone shape were independently associated with longitudinal change in pain and incident frequent knee pain respectively.Subchondral OA bone appears to be a relevant therapeutic target.PROSPERO registration number: CRD 42013005009.

View Article: PubMed Central - PubMed

Affiliation: Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapeltown Rd, Leeds, LS7 4SA, UK. a.barr@leeds.ac.uk.

ABSTRACT

Introduction: Bone is an integral part of the osteoarthritis (OA) process. We conducted a systematic literature review in order to understand the relationship between non-conventional radiographic imaging of subchondral bone, pain, structural pathology and joint replacement in peripheral joint OA.

Methods: A search of the Medline, EMBASE and Cochrane library databases was performed for original articles reporting association between non-conventional radiographic imaging-assessed subchondral bone pathologies and joint replacement, pain or structural progression in knee, hip, hand, ankle and foot OA. Each association was qualitatively characterised by a synthesis of the data from each analysis based upon study design, adequacy of covariate adjustment and quality scoring.

Results: In total 2456 abstracts were screened and 139 papers were included (70 cross-sectional, 71 longitudinal analyses; 116 knee, 15 hip, six hand, two ankle and involved 113 MRI, eight DXA, four CT, eight scintigraphic and eight 2D shape analyses). BMLs, osteophytes and bone shape were independently associated with structural progression or joint replacement. BMLs and bone shape were independently associated with longitudinal change in pain and incident frequent knee pain respectively.

Conclusion: Subchondral bone features have independent associations with structural progression, pain and joint replacement in peripheral OA in the hip and hand but especially in the knee. For peripheral OA sites other than the knee, there are fewer associations and independent associations of bone pathologies with these important OA outcomes which may reflect fewer studies; for example the foot and ankle were poorly studied. Subchondral OA bone appears to be a relevant therapeutic target.

Systematic review: PROSPERO registration number: CRD 42013005009.

No MeSH data available.


Related in: MedlinePlus

Search strategy results and article exclusion. *Two articles included both cross-sectional and longitudinal data. Longitudinal data included 16 case–control studies and 55 cohort studies
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Fig1: Search strategy results and article exclusion. *Two articles included both cross-sectional and longitudinal data. Longitudinal data included 16 case–control studies and 55 cohort studies

Mentions: A systematic literature search of Medline (from 1950), EMBASE (from 1980) and the Cochrane library databases until September 2014 was performed. A full description of the search terms used is recorded in Additional file 1: Table S1. An abbreviation of the full search terms used was ‘knee, hip, hand, foot and ankle’ and ‘osteoarthritis’ and ‘subchondral bone’ manifestations of OA (‘bone marrow lesion’, ‘osteophyte’, ‘bone cyst’, ‘bone area’, ‘bone shape’, ‘bone attrition’, bone morphometry and mineral density) and ‘MRI’ or ‘CT’ or ‘DXA’ or ‘scintigraphy’ or ‘PET’. The search term ‘bone shape’ was not restricted to non-conventional radiographic imaging. The final search was restricted to humans. There was no language restriction and abstracts were not excluded. Exclusion criteria are listed in Fig. 1. Any analysis of fewer than 20 patients with confirmed OA was excluded to remove papers at risk of study imprecision. The inclusion criteria were in vivo observational studies of a human population with clinical and/or radiographic OA, which included an imaging description of the adjacent subchondral bone pathology to the osteoarthritic joint and the relationship of this with pain, structural progression or joint replacement. Analyses describing the relationship between OA bone manifestations and structural severity (cross-sectional) or progression (prospective cohorts) in populations without clinical and radiographic OA were included to incorporate early structural features of joint degeneration. The outcome measures of structural severity or progression included cartilage defects, cartilage thickness, cartilage volume, denuded subchondral bone, Kellgren-Lawrence (KL)grade, joint space width and joint space narrowing. Other outcome measures included joint replacement and any pain measures.Fig. 1


A systematic review of the relationship between subchondral bone features, pain and structural pathology in peripheral joint osteoarthritis.

Barr AJ, Campbell TM, Hopkinson D, Kingsbury SR, Bowes MA, Conaghan PG - Arthritis Res. Ther. (2015)

Search strategy results and article exclusion. *Two articles included both cross-sectional and longitudinal data. Longitudinal data included 16 case–control studies and 55 cohort studies
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4548899&req=5

Fig1: Search strategy results and article exclusion. *Two articles included both cross-sectional and longitudinal data. Longitudinal data included 16 case–control studies and 55 cohort studies
Mentions: A systematic literature search of Medline (from 1950), EMBASE (from 1980) and the Cochrane library databases until September 2014 was performed. A full description of the search terms used is recorded in Additional file 1: Table S1. An abbreviation of the full search terms used was ‘knee, hip, hand, foot and ankle’ and ‘osteoarthritis’ and ‘subchondral bone’ manifestations of OA (‘bone marrow lesion’, ‘osteophyte’, ‘bone cyst’, ‘bone area’, ‘bone shape’, ‘bone attrition’, bone morphometry and mineral density) and ‘MRI’ or ‘CT’ or ‘DXA’ or ‘scintigraphy’ or ‘PET’. The search term ‘bone shape’ was not restricted to non-conventional radiographic imaging. The final search was restricted to humans. There was no language restriction and abstracts were not excluded. Exclusion criteria are listed in Fig. 1. Any analysis of fewer than 20 patients with confirmed OA was excluded to remove papers at risk of study imprecision. The inclusion criteria were in vivo observational studies of a human population with clinical and/or radiographic OA, which included an imaging description of the adjacent subchondral bone pathology to the osteoarthritic joint and the relationship of this with pain, structural progression or joint replacement. Analyses describing the relationship between OA bone manifestations and structural severity (cross-sectional) or progression (prospective cohorts) in populations without clinical and radiographic OA were included to incorporate early structural features of joint degeneration. The outcome measures of structural severity or progression included cartilage defects, cartilage thickness, cartilage volume, denuded subchondral bone, Kellgren-Lawrence (KL)grade, joint space width and joint space narrowing. Other outcome measures included joint replacement and any pain measures.Fig. 1

Bottom Line: BMLs and bone shape were independently associated with longitudinal change in pain and incident frequent knee pain respectively.Subchondral OA bone appears to be a relevant therapeutic target.PROSPERO registration number: CRD 42013005009.

View Article: PubMed Central - PubMed

Affiliation: Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapeltown Rd, Leeds, LS7 4SA, UK. a.barr@leeds.ac.uk.

ABSTRACT

Introduction: Bone is an integral part of the osteoarthritis (OA) process. We conducted a systematic literature review in order to understand the relationship between non-conventional radiographic imaging of subchondral bone, pain, structural pathology and joint replacement in peripheral joint OA.

Methods: A search of the Medline, EMBASE and Cochrane library databases was performed for original articles reporting association between non-conventional radiographic imaging-assessed subchondral bone pathologies and joint replacement, pain or structural progression in knee, hip, hand, ankle and foot OA. Each association was qualitatively characterised by a synthesis of the data from each analysis based upon study design, adequacy of covariate adjustment and quality scoring.

Results: In total 2456 abstracts were screened and 139 papers were included (70 cross-sectional, 71 longitudinal analyses; 116 knee, 15 hip, six hand, two ankle and involved 113 MRI, eight DXA, four CT, eight scintigraphic and eight 2D shape analyses). BMLs, osteophytes and bone shape were independently associated with structural progression or joint replacement. BMLs and bone shape were independently associated with longitudinal change in pain and incident frequent knee pain respectively.

Conclusion: Subchondral bone features have independent associations with structural progression, pain and joint replacement in peripheral OA in the hip and hand but especially in the knee. For peripheral OA sites other than the knee, there are fewer associations and independent associations of bone pathologies with these important OA outcomes which may reflect fewer studies; for example the foot and ankle were poorly studied. Subchondral OA bone appears to be a relevant therapeutic target.

Systematic review: PROSPERO registration number: CRD 42013005009.

No MeSH data available.


Related in: MedlinePlus