Versus Arthritis

To investigate changes in the prevalence of chronic pain (CP), high-impact chronic pain (HICP), and musculoskeletal health (MSK-HQ scores) before and after the COVID-19 pandemic. Longitudinal cross-sectional study using data from two population-based surveys conducted in 2016/17 (PRELIM) and 2022/23 (MIDAS-POP). Adults aged 35 and over registered with general practices in the West Midlands, UK, completed questionnaires including CP, HICP, and MSK-HQ. Entropy balancing was applied to match respondents across survey years on age, sex, deprivation, and ethnicity. Logistic and linear regressions estimated odds ratios (ORs) and mean differences. Subgroup analyses tested for interactions, and E-values were calculated to assess robustness to unmeasured confounding. CP prevalence increased from 35.6% in 2016/17 to 42.9% in 2022/23 (OR 1.36, 95% CI 1.22 to 1.51), and HICP from 15.5% to 22.4% (OR 1.57, 1.38 to 1.80). MSK-HQ scores among people with CP declined from 32.4 to 23.1, exceeding the minimal important change. Increases were more marked among women and people aged 35-54. Differences by deprivation and ethnicity were observed, although subgroup estimates for ethnicity should be interpreted cautiously due to small sample sizes. E-values suggested that the associations were moderately robust to unmeasured confounding. Chronic pain prevalence and its burden have increased since the COVID-19 pandemic, alongside declines in musculoskeletal health. While some of this may reflect residual confounding, the findings underscore the need for targeted pain prevention and management strategies, particularly for working-age adults and underserved groups.

In our previously reported trial of intra-articular tolerogenic dendritic cells (tolDC) as a treatment to restore immune tolerance in autoimmune arthritis, high doses of cells appeared to stabilise knee symptoms, although no systemic clinical or immunomodulatory effects were observed. We therefore sought to understand how tolDC affected the local synovial immune landscape. Synovial biopsies were taken at baseline and 14 days after intra-articular injection of tolDC or, as a control, saline washout. Histopathological analyses (Krenn evaluation and pathotype) and multiparametric imaging mass cytometry (IMC) were performed on paired synovial tissues from 7 participants (5 tolDC-treated and 2 controls), selected based on tissue availability at both time points. The IMC panel included 27 antibodies defining lymphoid, myeloid, and stromal cells. We observed no changes in the histopathology or the overall distribution of broadly classified cell populations (myeloid, lymphoid, and stromal) before and after tolDC administration. Furthermore, the proportions of CD4+ and CD8+ T cells were not altered, with no indication that tolDC had induced regulatory T cells within the synovium. However, we found a significant increase in a subset of myeloid cells expressing high levels of the inflammation resolution marker Mer tyrosine kinase (MerTKHigh), which positively correlated with tolDC dose. Moreover, the percentages of total MerTK+ myeloid cells inversely correlated with arthroscopic synovitis scores at both time points. The tolDC-induced increase in synovial Myeloid MerTKHigh cells may have local immune modulatory effects and provide promising evidence for an effect of tolDC treatment on the synovial immune landscape.

Opioid use for chronic non-cancer pain remains common in the UK, despite limited evidence of long-term effectiveness. Delirium, a serious acute confusional state associated with increased mortality, is a known adverse effect of opioid use. Pharmacological differences between opioids may influence delirium risk, but comparative evidence is scarce. This study evaluated the association of opioid type and dosage with the risk of in-hospital delirium in non-cancer patients. We conducted a retrospective cohort study using electronic health records (EHRs) from a tertiary care hospital in northwest England (September 26, 2014-December 31, 2020). Adult (≥ 18 years) without cancer who were administered with opioids during admission were included. Delirium was identified using the 4 'A's Test or through a combination of ICD-10 codes and new-onset confusion scores (= 3) on the National Early Warning Score. Daily opioid doses were converted to daily morphine milligram equivalents (MME/day) to assess the effect of dose across different opioid types. Incidence rates were calculated by opioid type and opioid dosage. Cox regression models, adjusted for confounders, were used to evaluate delirium risk. Among 50,586 opioid-exposed patients (mean [SD] age, 55 [20] years; 53% female), 867 patients (1.7%) experienced delirium during their first hospital admission (mean [SD] age, 75.1 [16.7] years). Compared to codeine, oxycodone (hazard ratio [HR] 3.52, 95% CI 2.77-4.46), fentanyl (HR 2.45, 95% CI 1.71-3.51), buprenorphine (HR 2.43, 95% CI 1.54-3.82), combination opioids (HR 2.22, 95% CI 1.63-3.02), and morphine (HR 2.15, 95% CI 1.65-2.79) were associated with significantly higher delirium risk. No clear dose-response association was observed: doses of 50-119 MME/day were not associated with a significant increase in risk compared to < 50 MME/day (HR 0.96, 95% CI 0.66-1.39). Using in-hospital medication administration records to capture opioid exposure, we found that oxycodone, fentanyl, buprenorphine, morphine, and combinationopioids were associated with increased delirium risk compared with codeine. Oxycodone was associated with a higher riskof delirium compared with both codeine and morphine. These findings support personalised opioid prescribing in non-cancer pain and can inform shared clinical decision-making to prevent delirium in patientsprescribed opioids.

There is no research evidence about how healthcare professionals (HCPs) prioritise assessment and management of pain in different paediatric chronic musculoskeletal conditions (e.g. inflammatory or non-inflammatory). This study investigated and compared paediatric rheumatology HCPs' pain assessment/management priorities in inflammatory and non-inflammatory chronic musculoskeletal conditions and explored perceived barriers to implementation of prioritised pain assessment/management approaches. Participants were presented with online vignettes describing a young person with an inflammatory (JIA) or non-inflammatory (diffuse idiopathic pain) chronic musculoskeletal condition. Participants completed closed questions on pain assessment/management priorities and open questions on perceived barriers to implementation of these priorities in clinical practice. Data were analysed using within-subjects bivariate statistical analysis and content analysis. Results from 56 HCPs (11 countries) found that broadly similar pain assessments were selected for both conditions. Biomedical management approaches were more frequently selected for the inflammatory condition, whereas psychosocial approaches were primarily selected for the non-inflammatory condition. Barriers to implementation of assessment/management approaches included limited time, resources, knowledge and skillset and HCPs' habits and beliefs about pain care (e.g. limiting access to components of biopsychosocial pain management due to preconceived beliefs about the musculoskeletal condition). Paediatric rheumatology HCPs generally prioritise similar pain assessments for inflammatory and non-inflammatory chronic musculoskeletal conditions. However, some HCPs perceive psychosocial pain management approaches as less important for managing pain in inflammatory conditions. Importantly, pain is always biopsychosocial in nature and clinical guidelines (that emphasise the biopsychosocial perspective) should ideally be followed regardless of condition type.

Beyond Lethargy

Musculoskeletal injuries (MSKIs) are a leading cause of medical downgrades and reduced operational effectiveness in the UK military. Initial military training presents a high-risk period for sustaining MSKI but also provides an important opportunity for promoting positive health-related behaviours to mitigate future MSKI risk. Self-determination theory suggests that environments supporting basic psychological needs of autonomy, competence and relatedness can foster intrinsic motivation regulation and positive health-related behaviours. However, this link between environment and behaviour remains underexplored in military populations. Weight-related health risk (determined from individual body weight, height and waist circumference) and health behaviours (relative to the Defence Health Behaviour Index) were assessed in 1591 Royal Navy participants (15.6% females; age range 16-61 years), comprising 941 recruits, 190 officer cadets and 460 trained personnel. Participants also completed the Work Behaviour Regulation Questionnaire and Basic Psychological Need Satisfaction and Frustration Scale. Linear regression and Multivariate Analysis of Covariance were used to explore relationships and group differences. Supporting basic psychological needs in the workplace was positively associated with autonomous motivation (p<0.002), which was also associated with more favourable health behaviours (β=0.119, p<0.001). Frustrating psychological needs were associated with controlled motivation (p<0.001) and poorer health behaviours (β=0.082, p=0.006). Trained personnel reported higher weight-related ill-health risk, poorer health behaviours and greater psychological need frustration than trainees (p<0.001). Recruit trainees had the highest psychological need satisfaction but also the greatest introjected and external motivation regulations (driven by internal pressures or external rewards). Female and trained personnel exhibited greater weight-related ill-health risk (OR=0.51, p<0.001). The data suggest that creating need-supportive military environments fosters autonomous motivation-promoting positive health-related behaviours. Establishing need-supportive environments during early-career phases could improve effectiveness in supporting positive health behaviours and mitigating MSKI risk.

Female, woman and/or girl athletes’ sport participation rates are rising and associated with high injury rates and burden. Using best-practice consensus methodology, we developed recommendations to guide injury prevention for female/woman/girl athletes. The Female/woman/girl Athlete Injury pRevention (FAIR) International Olympic Committee Consensus meeting was held from 31 March to 2 April 2025 (Lausanne, Switzerland).The FAIR Consensus followed an eight-step hybrid method. 109 authors from six continents conducted: (1) systematic reviews synthesising evidence on injury prevention strategies and modifiable risk factors for lower-extremity and upper-extremity injuries, concussions and spine/chest/abdominal/pelvic injuries/pain, (2) a scoping review synthesising dissemination and implementation (D&I) approaches; and (3) a concept mapping project generating knowledge on gender/sex-related factors for injury prevention. These projects underpinned draft recommendations subsequently voted on by a steering committee (n=24) and an external advisory committee chair over two anonymous survey rounds. Recommendations, Round 1 voting results and suggestions/dissenting comments were discussed between Round 1 and 2 voting. Consensus was defined as ‘critical to include’ (≥70% scored recommendation as 7–9 (9-point Likert scale, 1=not important; 9=critically important) AND ≤15% scored recommendation as 1–3).The 56 FAIR recommendations address: primary injury prevention (n=16) (policy/rules/laws=6; personal protective equipment=8; training=2); secondary injury prevention (n=4); modifiable risk factors (n=12); approaches to D&I (n=14); and promoting gender/sex-supportive environments (n=10).The FAIR Consensus informs evidence-based best practices and policy for injury prevention, approaches to implementation and creation of supportive environments for female/woman/girl athletes. Every person at all levels of sport can, and should, take responsibility for actions that positively influence female/woman/girl athlete health and safety.

ABSTRACTBackgroundCurrent care provided by health professionals for individuals with osteoarthritis (OA) is inconsistent with clinical guideline recommendations. Although OA guidelines have been developed for more commonly studied joints such as the knee and hip, foot OA remains comparatively underrepresented. Despite its high prevalence and significant impact on functional ability, foot OA lacks standardised classification criteria. The absence of clinical guidelines for foot OA underscores its importance as a research priority. Understanding current assessment and management strategies is crucial before designing clinical trials. This study aims to assess New Zealand (NZ) podiatrists' knowledge of foot OA, their assessment practices and their management strategies. Although foot OA is both highly prevalent and functionally disabling, the absence of standardised classification criteria persists.MethodsA qualitative descriptive approach was employed for data collection and analysis. Using purposive sampling, semistructured interviews were conducted with 10 NZ registered podiatrists. An interview schedule guided discussions on diagnosing and managing foot OA. Interviews were audio‐recorded and transcribed verbatim. Reflexive thematic analysis was used to identify key meanings and patterns within the data.ResultsFive key themes were derived regarding the assessment of foot OA: (1) chief complaint versus incidental finding; (2) obtaining patient history through subjective interviews; (3) targeted objective assessments for foot OA; (4) determining individual biomechanical factors and (5) further investigations. Five themes were identified relating to the management of foot OA: (1) knowledge and language used to provide education about OA; (2) clinical uncertainty necessitates an iterative approach; (3) podiatry administered treatments; (4) referral pathways to other health professionals and (5) management influences.ConclusionNew Zealand podiatrists utilise a comprehensive diagnostic approach, integrating symptom history, joint mobility assessment and radiographic imaging particularly in the absence of formal diagnostic criteria. Management strategies align with international guidelines, emphasising education, exercise and weight management alongside podiatrist‐led interventions such as foot orthoses and footwear modifications. However, the study highlights several challenges: limited evidence‐based guidance, uncertainty around optimal orthotic strategies and a disconnect between evolving OA knowledge and its application into clinical practice.