4.4 Review

Review of publications evaluating opioid use in patients with inflammatory rheumatic disease

Journal

CURRENT OPINION IN RHEUMATOLOGY
Volume 34, Issue 2, Pages 95-102

Publisher

LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/BOR.0000000000000868

Keywords

inflammatory arthritis; opioid; pain

Categories

Funding

  1. Rheumatology Research Foundation
  2. NIH/NIAMS [P30AR070155, K24AR074534]

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This article discusses the prevalence, efficacy, and safety of opioid analgesics in patients with rheumatic diseases. Recent studies show long-term opioid use is common in patients with inflammatory rheumatic disease, but there is no evidence to support its efficacy in pain control and function improvement. Some data shows potential adverse effects including increased risk for fractures and opioid poisoning hospitalizations.
Purpose of review This article discusses publications assessing the prevalence, efficacy, and safety of opioid analgesics in patients with rheumatic diseases, including rheumatoid arthritis, systemic lupus erythematosus, psoriatic arthritis, ankylosing spondylitis, and systemic sclerosis. Recent findings Recent studies show long-term opioid use is common in patients with inflammatory rheumatic disease. We did not find any studies demonstrating improved function or pain control with long-term opioid use in people with rheumatic diseases. Some data shows potential adverse effects including increased risk for fractures and opioid poisoning hospitalizations. There is evidence demonstrating an association of opioid use with mental health disorders, fibromyalgia, obesity, and disability, although causative links have not been established. Only minimal reductions in opioid use were observed after initiation of biologic disease modifying antirheumatic drugs (DMARDs). Studies have shown delayed DMARD initiation and reduced DMARD use in patients on opioids, raising concerns that these analgesics may delay care or initially mask symptoms of active disease. Summary Available literature highlights high levels of opioid use in people with rheumatic disease, without scientific evidence to support efficacy for chronic pain control and increasing evidence of adverse events. These findings strongly suggest that opioids do not have a routine role in the chronic management of inflammatory rheumatic diseases.

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