title: A systematic review of the relationship between subchondral bone features, pain and structural pathology in peripheral joint osteoarthritis.
abstract: BACKGROUND
  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.
  
  
  CONCLUSIONS
  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.
  PROSPERO registration number: CRD 42013005009.
authors: 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.
authors: Andrew J
authors: AJ
authors: Barr
authors: Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapeltown Rd, Leeds, LS7 4SA, UK. tcampbell@bruyere.org.|Department of Medicine, University of Ottawa, Ottawa, Canada. tcampbell@bruyere.org.
authors: T Mark
authors: TM
authors: Campbell
authors: Imorphics Ltd, Kilburn House, Manchester, UK. dehop24@gmail.com.
authors: Devan
authors: D
authors: Hopkinson
authors: Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapeltown Rd, Leeds, LS7 4SA, UK. s.r.kingsbury@leeds.ac.uk.
authors: Sarah R
authors: SR
authors: Kingsbury
authors: Imorphics Ltd, Kilburn House, Manchester, UK. mike@imorphics.com.
authors: Mike A
authors: MA
authors: Bowes
authors: Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapeltown Rd, Leeds, LS7 4SA, UK. p.conaghan@leeds.ac.uk.
authors: Philip G
authors: PG
authors: Conaghan
mesh_terms: D018771:Arthralgia / Q000473:pathology*; D015519:Bone Density; D001842:Bone and Bones / Q000473:pathology*; D002358:Cartilage, Articular / Q000473:pathology; D003430:Cross-Sectional Studies; D003952:Diagnostic Imaging / Q000379:methods; D006801:Humans; D007596:Joints / Q000473:pathology*; D010003:Osteoarthritis / Q000473:pathology*; D054850:Osteophyte / Q000473:pathology