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Opioid Use for Ankylosing Spondylitis More Likely Linked to Subjective Disease Measures
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The use of opioids among patients with ankylosing spondylitis is more likely to be associated with subjective measures, such as depression, than objective measures like C-reactive protein levels and erythrocyte sedimentation rate, according to findings published in the Journal of Rheumatology.
The researchers noted that other sources aside from spinal inflammation could be the cause of pain in ankylosing spondylitis.
“This study was important because it addresses a key issue facing practitioners at present — the opioid epidemic and the interaction of opioids with other psychoactive medications,” John D. Reveille, MD, of the McGovern Medical School at the University of Texas Health Science Center, in Houston, told Healio Rheumatology. “This is the first study to address the issue of opioid usage in patients with ankylosing spondylitis, and hopefully it will lead to additional studies addressing potential nonpharmacologic approaches to pain control in these patients.”
To analyze the factors associated with opioid use among patients with ankylosing spondylitis, the researchers recruited a prospective cohort of 706 participants who were evaluated for disease activity and functional impairment for 2 years with the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and the Bath Ankylosing Spondylitis Functional Index (BASFI). In addition, the researchers determined radiographic severity using the Bath Ankylosing Spondylitis Radiology Index and modified Stokes Ankylosing Spondylitis Scoring System.
At each study visit, held every 6 months, the researchers evaluated which medications the patients received concurrently with opioids, as well as the patients’ C-reactive protein levels and erythrocyte sedimentation rate. They developed longitudinal multivariable models to identify factors independently associated with patients’ opioid use over time.
According to the researchers, longer disease duration, smoking, low exercise, high disease activity on BASDAI, functional impairment on BAFSI, depression, radiographic severity and cardiovascular disease were all significantly associated with opioid use, and particularly chronic opioid use. In addition, patients who received opioids were more likely to also use anxiolytic, hypnotic, antidepressant and muscle relaxant drugs. The researchers’ multivariable model emphasized the link between opioid use and smoking, older age, the use of antitumor necrosis factor (TNF) agents and psychoactive drugs, as well as with subjective indicators of disease activity.
“The key takeaways are that patients taking opioids, especially those taking opioids chronically, are more likely to be depressed, have greater functional impairment and subjective disease activity, and to be taking other psychoactive drugs, especially anxiolytics and hypnotics,” Reveille said. “However, there was not a correlation with objective markers of disease activity or radiographic severity. Given that those taking opioids were more likely to be smokers, and, at least on the univariable analyses, to not be exercising, this suggests nonpharmacologic approaches are key in addressing pain management in patients with ankylosing spondylitis. Also, the finding of slightly lower usage of opioids in those taking anti-TNF medications suggests that control of disease activity is still important here.” – by Jason Laday
Disclosure: Reveille reports no relevant financial disclosures.
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