Study Finds Chronic Opioid Use Doubled in Rheumatoid Arthritis Patients

Dr. Solomon

“[Although] almost all patients with RA have some degree of chronic pain, the vast majority do not require chronic opioids,” says the study’s senior author, Daniel H. Solomon, MD, MPH, a professor of medicine in the Division of Rheumatology and Immunology at Harvard Medical School, Boston. He added that he and colleagues, in a study yet to be published, found “some rheumatologists are more likely to give chronic opioids than other rheumatologists, even after controlling for patient factors.”

This observation supports data previously published by Curtis et al. that found “tremendous variability” in how U.S. rheumatologists prescribe opioids.²

“[Although] overall, about 40% of older RA patients used opioids, in some rheuma­tology practices it was more than 80% and in other practices it was less than 10%,” says Jeffrey R. Curtis, MD, MPH, the Marguerite Jones Harbert–Gene V. Ball Endowed Professor of Medicine in the Division of Clinical Immunology & Rheumatology at the University of Alabama, Birmingham.

Clinical Takeaways

Dr. Curtis

Given a lack of data on long-term benefit of opioids, Dr. Curtis says, “I [think] that as a bridge to therapy, opioids may be okay in the short term, but it would be highly desirable to get people off them if possible.

“Similar to glucocorticoid management, clinicians may forget they should try to taper opioids as patients’ disease activity improves with effective RA therapy,” he says.

Dr. Curtis also emphasizes the predictive association between antidepressant use and chronic opioid use found in the study by Lee et al. “I think rheumatologists may not be as sensitized to thinking about the need to screen for depression in these patients, but this work underscores the importance of doing so.”

Dr. Solomon says the key to helping RA patients is to treat the RA early and completely as guidelines recommend. Although he thinks patients with chronic pain not controlled by other means are candidates for opioids, he stresses the substantial risk of chronic opioid use. 

Mary Beth Nierengarten is a freelance medical journalist based in Minneapolis.

References

1. Lee YC, Kremer J, Guan H, et al. Chronic opioid use in rheumatoid arthritis: Prevalence and predictors. Arthritis Rheumatol. 2019 May;71(5):670–677.
2. 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(9):1733–1740.
3. Zamora-Legoff JA, Achenbach SJ, Crowson CS, et al. Opioid use in patients with rheumatoid arthritis 2005–2014: A population-based comparative study. Clin Rheumatol. 2016 May;35(5):1137–1144.