Study: X-rays, opioid drugs overused for increasing number of OA cases in the UK

In the United Kingdom, there was an increased number of new clinical osteoarthritis cases. These cases continued to be imaged with plain radiography and were increasingly managed with opioid analgesic medications, according to recently published findings.
In the descriptive study, researchers used longitudinal data from the U.K. Clinical Practice Research Datalink. They used two classifications for osteoarthritis (OA) cases. Clinical OA cases had at least one doctor’s visit with a recorded diagnosis of OA; or in patients older than 45 years, at least one physician consultation with a documented peripheral joint pain symptom code specific to the knee, hip or hand/wrist. A second category, defined simply as OA, required at least one physician consultation with a recorded OA diagnosis. They identified 1,716,253 incident cases of clinical OA and 432,163 cases of OA documented between 1992 and 2013.
In 2013, the age-sex standardized incidence rate for clinical OA was 40.5 per 1,000 person-years. For OA, the rate was 6.3 per 1,000 person-years. Using both case definitions, women had higher age-standardized incidence rates vs. men. The rates peaked at 75 years to 84 years for both genders. Overall, 16.4% of clinical OA cases and 22% of OA cases were referred for an X-ray at the time of diagnosis. There was a high prevalence of multi-morbidity, with 51% of incident clinical OA cases and 74.9% of incident OA cases associated with prescriptions for more than 5 unique types of drug within the previous year.

A small increase in age-standardized incidence rates of diagnosed OA between 1992 and 2004, but these rates subsequently dropped. Clinical OA also demonstrated largely consistent annual standardized incidence rates between 1992 and 2000. These rates then increased notably until 2009, after which these dropped slightly.
In almost every age group, later birth cohorts had higher clinical OA incidence rates vs. earlier birth cohorts. Cohorts born after the 1950s demonstrated a rising incidence of clinical OA, especially in women, while OA decreased in incidence. This incidence went from 8.6/1,000 person-years in 2004 down to 6.3 in 2013. The use of NSAID prescriptions decreased from 2004, and weak combination opioids became the most prevalent class of prescribed analgesia from 2005 through the study period. An increase was also seen in the percentage of incidence OA cases being prescribed “very” strong opioids. These percentages rose from 0.1% in 2004 to 0.5% in 2013 for clinical RA, and from 0.6% in 2006 and 1.2% in 2013 for OA.
“Between 1992 and 2013, the age-standardized incidence of all clinical OA increased, while that of diagnosed OA remained stable or even declined,” the researchers wrote. “Amid strong period effects, cohorts born after the mid-1950s are showing higher incidence rates of clinical OA than previous generations of the same age. Prescribed opioid analgesia and plain radiography appear to be overused.” -by Jennifer Byrne

Disclosures: The researchers report no relevant disclosures.

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Yu D, et al. Rheumatology. 2017; Rheumatology, kex270, https://doi.org/10.1093/rheumatology/kex270