Chronic opioid use rising in RA patients
medwireNews: Chronic opioid use among patients with rheumatoid arthritis (RA) increased substantially between 2002 and 2015, researchers report.
Yvonne Lee (Brigham and Women's Hospital, Boston, Massachusetts, USA) and co-authors also identified a number of patient- and disease-related factors associated with the continued use of these drugs.
Among 33,739 RA patients from the Corrona registry with at least 90 days of follow-up, the annual prevalence of chronic opioid use – defined as self-reported opioid use on questionnaires from at least two consecutive visits (median interval=156 days) – increased from 7.4% in 2002 to 16.9% in 2015.
In contrast to previous studies demonstrating a plateau in opioid use after 2010 in the general population, Lee and colleagues stress that chronic opioid use continued to rise between 2010 and 2015 in their study of RA patients, with an annual prevalence of approximately 12% in 2010.
The researchers found that the strongest predictor of chronic opioid use was severe pain. Among the 26,288 patients who were not taking opioids at baseline, those who reported a severe, moderate, or low degree of pain (>60, >40–60, and 10–40 on a scale of 1–100, respectively) in the previous week were significantly more likely to have chronic opioid use over the study period than those who did not report pain, with corresponding adjusted hazard ratios (HRs) of 2.53, 2.23, and 1.56.
The use of antidepressants was also significantly associated with chronic opioid use (adjusted HR=1.79), along with corticosteroid treatment (adjusted HR=1.14), and having Medicaid or Medicare insurance (adjusted HR=1.30 and 1.27, respectively, vs private insurance).
Moreover, patients with high, moderate, and low disease activity (CDAI >22, 10–22, and >2.8–10, respectively) were significantly more likely to report chronic opioid use than those who were in remission, as were those with a HAQ-DI score of more than 0.5 relative to patients with a lower score.
Together, these findings support the importance of “treating inflammatory disease activity aggressively with a treat-to-target strategy,” and “evaluating and treating pain and mental health problems, before prescribing opioid medications,” write the investigators in Arthritis & Rheumatology.
And they conclude: “To curb the rise in chronic opioid use, strategies for stringent control of RA disease activity and management of pain and depression should be research priorities.”
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