title: Ligament and bone pathologic abnormalities more frequent in neuropathic joint disease in comparison with degenerative arthritis of the foot and ankle: implications for understanding rapidly progressive joint degeneration.
abstract: OBJECTIVE
  The variable disease progression of osteoarthritis (OA) and the basis for rapid joint deterioration in some subgroups of patients are poorly understood. To explore an anatomic basis for rapidly progressive OA, this observational study compared the magnetic resonance imaging (MRI) patterns of disease between patients with neuropathic joint disease (NJD) and patients with degenerative arthritis of the ankle and foot.
  
  
  METHODS
  MR images of the foot and ankle of patients with early NJD (n = 7) and patients with OA (n = 15) were assessed. The anonomized MR images were dichotomously scored by a musculoskeletal radiologist for the presence of the following abnormalities per bone (of a total of 14 bones): cartilage defects, bone cysts, bone marrow edema, fractures, joint debris, joint effusions, tendinopathy, tendinitis, and ligament tears.
  
  
  RESULTS
  Although the degree of cartilage damage and joint cyst formation was comparable between the groups, the degree of ligament tears, or change in MRI signal intensity in the ligaments, was significantly greater in patients with NJD compared with patients with OA (median of 3 tears versus 0, of 14 total bones; P < 0.01). Moreover, in patients with early NJD compared with patients with OA, there was a significantly greater degree of diffuse bone marrow edema (median of 6.5 tarsal bones versus 2 adjacent bones, of 14 total bones; P < 0.01), a greater number of bone fractures (median 4 versus 0; P < 0.01), and more frequent bone debris (median 4.5 versus 0; P = 0.013).
  
  
  CONCLUSIONS
  This analysis of NJD in the foot and ankle shows the predominance of bone and ligament abnormalities in NJD compared with the pattern of involvement in OA. These findings highlight the importance of structures other than articular cartilage in OA of the ankle and foot, and suggest that rapid joint degeneration in NJD may be more ligamentogenic or osteogenic in nature.
authors.affiliation: University of Leeds, Leeds, UK.
authors.forename: Jill
authors.initials: J
authors.lastname: Halstead
authors.forename: Diane
authors.initials: D
authors.lastname: Bergin
authors.forename: Anne-Maree
authors.initials: AM
authors.lastname: Keenan
authors.forename: Julie
authors.initials: J
authors.lastname: Madden
authors.forename: Dennis
authors.initials: D
authors.lastname: McGonagle
mesh_terms: D000328:Adult; D000368:Aged; D001177:Arthropathy, Neurogenic / Q000473:pathology*; D001842:Bone and Bones / Q000002:abnormalities* / Q000473:pathology; D002358:Cartilage, Articular / Q000002:abnormalities / Q000473:pathology; D018450:Disease Progression; D005260:Female; D033023:Foot Joints / Q000002:abnormalities* / Q000473:pathology; D006801:Humans; D008023:Ligaments, Articular / Q000002:abnormalities* / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000473:pathology*; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D052256:Tendinopathy / Q000473:pathology