Anthony V. Perruccio

Objectives: The primary aim of this scoping review was to synthesise published research priorities for back pain, neck pain and osteoarthritis. The secondary aim was to compare these research priorities to the priority areas identified in the Global Strategy to Improve Musculoskeletal Health. Design: Scoping review conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews. Data sources: Literature searches were performed in MEDLINE, EMBASE and the James Lind Alliance Priority Setting Partnership database from inception to March 2025. Eligibility criteria: Peer-reviewed studies reporting the development of a prioritised ranking of research topics related to back pain, neck pain or osteoarthritis were included. Data synthesis: Included research priority sets were described. All research priorities for back pain, neck pain and osteoarthritis were presented. Research priorities were categorised according to priority areas identified in the Global Strategy to Improve Musculoskeletal Health. Results: 15 studies from 3721 citations and three from the James Lind Alliance were included. Eight priority sets related to back and/or neck pain identified 155 research priorities. 15 priority sets related to osteoarthritis identified 206 research priorities. Most priority sets (69.6%) included patients in the development process, but only 17.4% included policymakers. Just three priority sets included participants from outside Europe, North America or Australia. Most priorities were in the clinical and basic science research priority area (73.1%) followed by the health policy and systems research priority area (14.1%), health economics research priority area (4.7%), public health research priority area (4.4%), epidemiological and population health research priority area (1.9%) and the other priority area (1.7%). Conclusions: The majority of published back pain, neck pain and osteoarthritis research priorities fall within clinical and basic science and were developed in high income countries. Given the known high population burden of musculoskeletal conditions, a broader approach to research beyond clinical and basic science is likely required to achieve population-level health benefits. Future initiatives should include all relevant members of the global musculoskeletal health community, including from low- and middle-income countries, to help ensure the development of broad-based research priorities that address all research domains required to improve back and neck pain and osteoarthritis health globally.

Purpose: This study aimed to identify metabolic biomarkers and pathways that might be associated with total joint arthroplasty (TJA) early revision for heterogeneous failure modes using an individual data meta-analysis of metabolomics. Methods: Two independent osteoarthritis (OA) cohorts were included. Revision records of patients with primary knee and hip OA were extracted at an average of 11.1 and 7.8 years after primary TJA, respectively. Preoperative fasting plasma was metabolomically profiled. Concentrations of metabolites/metabolism indicators were natural log-transformed, and their associations with early revision for all reasons in each individual cohort were assessed using logistic regression; the summary statistics from each cohort were then subjected to random-effects meta-analysis modelling. Results: Five hundred seventy-two patients with primary OA in The Newfoundland Osteoarthritis Study and 368 in the Longitudinal Evaluation in the Arthritis Program: Osteoarthritis Study were included. The revision rates were 4% and 6%, and mean times to revision were 1.7 and 2.1 years, respectively. No metabolite reached the prespecified significance threshold for multiple testing correction. However, 119 metabolites including choline, tryptophan betaine, indole, ornithine, three acylcarnitines, four cholesteryl esters, two lysophosphatidylcholines, five long-chain diglycerides, and 101 unsaturated (very) long-chain triglycerides were nominally significant with P < 0.05, suggesting potential links between these metabolites and early revision. Among these, indole and one acylcarnitine were positively associated with revision (odds ratio ≥1.73), while all others were negatively associated (odds ratio ≤0.73). Conclusion: Overactivation of the tryptophan-indole metabolic pathway may be associated with early revision after primary TJA. However, the findings were suggestive and represented a composite signal from heterogeneous failure modes.

Background: Despite broad calls to consider sex-specific effects in treatment/intervention studies, this remains a persistent gap. This study sought to identify presurgery factors associated with pain and physical function following hip and knee total joint arthroplasty (TJA) for osteoarthritis, specifically adopting a sex-stratified approach. Methods: Questionnaires were patient-completed presurgery: sociodemographic and health-related characteristics, anxiety and depression symptoms, neuropathic-like pain symptoms, multijoint involvement, and opioid use. Pain and physical function were captured presurgery and 1 year postsurgery. Study outcomes: pain and function status scores at 1 year and their percentage change (presurgery to 1 year postsurgery). Associations between presurgery factors and outcomes were assessed by sex-stratified multivariable linear regressions. Findings were contrasted against a sex-adjusted approach (i.e. one analysis in combined male/female sample). Results: Sample (45% hip, 55% knee): 787 female patients and 640 male patients. Among male patients only: Depressive symptoms were associated with worse pain and function status, and less pain improvement (β = −8.6% [−17.4%, 0.3%]), as were lower education and living alone. Among female patients only: Anxiety symptoms were associated with worse pain and function status and less pain (β = −7.7% [−14.3%, −1.0%) and functional improvement (β = −8.5% [−14.4%, −2.6%]), as was greater multijoint burden. The negative effect of neuropathic-like pain symptoms was greater in male patients than female patients. Sex-adjusted findings suggested sex had no consequence. Conclusions: Several factors uniquely influenced TJA outcomes by sex. Simple sex-adjustment may miss important effects. This has broad implications, including for patient education, decision making, prognostic/comparative effectiveness study design, and development/improvement of prediction algorithms. Though TJA focused, we hypothesize that sex differences are likely relevant in other clinical populations. Level of Evidence: Prognostic Level I . See Instructions for Authors for a complete description of levels of evidence.

The Pediatric PainSCAN is the first screening tool for neuropathic pain (NP) and complex regional pain syndrome (CRPS) designed for pediatrics. Prior research developed the tool and established content validity. The tool has 3 parts, part A is a preface (pain location, severity, duration), part B discriminates NP or CRPS from other pain conditions, and part C discriminates CRPS from NP. This study aimed to evaluate the tool's reliability and validity. A multicentre cross-sectional survey was administered to participants with NP, CRPS, and other pain conditions in pediatric chronic pain clinics. Test–retest reliability was evaluated by readministering the tool after 7 days. Criterion validity (sensitivity [SE] and specificity [SP]) was evaluated by comparing participant scores to a clinician diagnosis. Convergent validity was evaluated by comparing participant scores on the tool to existing NP screening tools. Participants (N = 221; 56 with NP, 57 with CRPS, 108 with other pain) were aged 9 to 18 years and 81% female. Test–retest reliability (intraclass correlation coefficients part B = 0.76 and part C = 0.82) was sufficient (>0.70). Criterion validity (part B: SE 76%, SP 63%; part C: SE 83%, SP 77%) was sufficient (>70%) except for SP of part B. Convergent validity was sufficient (correlation coefficients aligned with hypotheses: painDETECT [0.73], self-report Leeds Assessment of Neuropathic Symptoms and Signs [0.73], and Patient-Reported Outcome Measurement Information System Neuropathic Pain Quality [0.59]). The Pediatric PainSCAN demonstrated sufficient reliability and validity to screen for NP and CRPS in pediatric chronic pain clinics. Future research is needed to evaluate the tool in other settings and determine the utility of implementing the tool in clinical practice.

Objective: To compare the prevalence and examine the likelihood of insomnia symptoms in middle- and older-aged adults with an osteoarthritis (OA) diagnosis and with joint symptoms indicative of OA but without a diagnosis, in a population-based sample. Methods: Data are from the Canadian Longitudinal Study on Aging (participants aged >45). Individuals reported on doctor-diagnosed OA (hand, hip, or knee) and joint symptoms typical of OA, irrespective of OA diagnosis. A three-level ‘OA-status’ variable was derived: diagnosed OA; joint symptoms-no OA; no symptoms-no OA (controls). Participants responded to sleep-related questions and were categorized as experiencing insomnia symptoms (yes/no). Logistic regression analysis examined the association between insomnia symptoms and OA status, adjusting for a number of covariates. Results: Of 21,422 respondents, OA was reported by 29.1% (mean age 68.2) and 17.2% reported joint symptoms-no OA (mean age 63.9). One third of those with diagnosed OA and with joint symptoms-no OA reported insomnia symptoms compared to a quarter of controls. Those with OA and with joint symptoms-no OA were similarly more likely to report insomnia symptoms than controls (odds ratio (OR) 1.25, 95% CI 1.17–1.35 and OR 1.32, 95% CI 1.21–1.43). Also significantly associated with insomnia symptoms were female sex, current smoker, lower activity level, multiple chronic conditions and depressive symptoms. Odds ratio magnitudes were greatest for depressive symptoms (OR 2.50, 95% CI 2.26–2.76), comorbidity count (3 + vs. 0 OR 1.68, 95% CI 1.47–1.91) and female sex (OR 1.46, 95% 1.37–1.55). Conclusion: Insomnia symptoms were not uncommon among comparatively younger individuals with typical OA joint symptoms and those with OA. This suggests that healthcare providers should address sleep-related issues in those consulting for joint pain, irrespective of diagnosis. Given their high prevalence, this also has implications for sleep-related issues at a population level.

Objective: The purpose of the study is to examine the relationship between osteoarthritis (OA) and joint symptoms typical of OA and labor force participation.Methods: Data are from the baseline questionnaire of the Canadian Longitudinal Study on Aging for respondents aged 45 to 74 years at baseline (n = 24,427). Individuals were categorized into one of five mutually exclusive arthritis status groups: diagnosed OA, diagnosed other type of arthritis, two to three symptomatic joint sites and no diagnosed arthritis, one symptomatic joint site and no diagnosed arthritis, and no arthritis and no joint symptoms. Age‐stratified robust log‐Poisson regression analysis was used to examine the association between arthritis status and labor force participation.Results: Overall, 39% of the analytic sample reported being out of the labor force. Those with OA aged 45 to 54 and 55 to 64 years were significantly more likely to be out of the labor force than those with no arthritis or no joint symptoms, with prevalence ratios (PRs) of 1.34 (95% confidence interval [CI] 1.10–1.65) and 1.13 (95% CI 1.06–1.21), respectively, with similar results for those with two to three joint symptoms and no OA in the 45 to 54 years age group (PR 1.37 [95% CI 1.07–1.76]). There was no difference for those aged 65 to 74 years. Being an informal caregiver increased the likelihood of nonparticipation in the labor force for those aged 55 to 64 years (PR 1.09 [95% CI 1.04–1.15]).Conclusion: Our results suggest that an exclusive reliance on an OA diagnosis to understand impact on labor force participation may miss a large segment of the middle‐aged population, which may have undiagnosed OA or be at greater risk of OA because of joint problems.

Objective: Osteoarthritis (OA) is frequently perceived as a disease of the elderly and an inevitable result of aging. Because OA studies often are restricted to older adults, there is limited information on OA in younger adults. This study describes the burden of OA across a wide age range and compares younger and older adults.Methods: Descriptive analysis of the Survey on Living with Chronic Diseases in Canada – Arthritis Component, a nationally representative survey of Canadians ≥20 years who reported an arthritis diagnosis in the Canadian Community Health Survey, a general health population survey. Analyses were restricted to those reporting OA and no other kind of arthritis (n = 1,749).Results: In the representative group with OA, 55.4% were younger than 65 years. The mean age at diagnosis was 50 years, with 30.4% reporting being diagnosed before age 45 years. Younger adults reported similar symptom severity as their older counterparts with OA regarding the mean number of affected joint sites, severity of pain and fatigue, and activity limitations. In the youngest age group, those with OA were significantly more likely to report fair or poor overall and mental health and life dissatisfaction compared with their general counterparts; the same was not the case in the oldest age group.Conclusion: OA is not uncommon among younger and middle‐aged adults, and they experience OA impacts comparable with those for older adults. These findings suggest that younger adults with OA will live many years with symptoms and disability and highlight a need for effective OA management across ages.