Conclusions: In the U.S., opioid use in older patients with RA peaked in 2010 and is now declining slightly. Withdrawal of propoxyphene from the U.S. market in 2010 had minimal effect on overall opioid use, because propoxyphene use was replaced by increased use of other opioids. Opioid use varied considerably by state, suggesting that some regional variability may be attributable to state regulations in opioid prescribing.
The study’s results suggest substantial use of opioids in a population of older RA patients despite societal concerns regarding potential overprescribing in recent years. Rheumatologists played a significant prescribing role, although co-prescribing was relatively common.
Rheumatologists and other clinicians caring for patients with RA face a significant dilemma precisely because the options for treating pain remain problematic. The proven benefits of opioids for the treatment of RA-related pain, as well as other types of musculoskeletal pain syndromes, are restricted to trials of shorter duration, tend to be modest in magnitude and include the risk of side effects. The benefits of nonpharmacologic treatments are similarly modest in magnitude and limited to short-duration studies.
Although the current findings are insufficiently granular to prove inappropriate practice, they do raise concerns for practitioners.
Excerpted and adapted from:
Curtis JR, Xie F, Smith C, et al. Changing trends in opioid use among patients with rheumatoid arthritis in the United States. Arthritis Rheumatol. 2017 Sep;69(8).
