OBJECTIVES : Rheumatoid arthritis is a chronic autoimmune systemic inflammatory disease that is progressive and incurable. It can result is debilitating pain, which is often treated with opioids. However, the adverse effects associated with opioid use, such as opiate dependency and narcotic bowel syndrome, may offset the benefits from these medications. The goal of this study was to analyze opioid usage within a patient cohort with rheumatoid arthritis stratified by type of visit and patient-reported pain scores.

METHODS : A US electronic health record dataset (Cerner Health Facts®) of over 450 million patient visits was examined. Visits involving adult patients (≥18 years) with a principal ICD-9/10 diagnosis for rheumatoid arthritis between 2012 and 2016 were retrospectively analyzed. Visit-based medication data was assessed. The VA drug classification system (2016) was used to define ‘opioid analgesics’. Each visit was designated a pain group of mild, moderate, or severe based on the highest pain score per visit (Numeric Pain Scale 0-10).

RESULTS : The study included 272,939 rheumatoid arthritis visits, with 79% comprising female patients vs. 21% male patients, and a mean age of 59.2 years. Inpatient visits made up 1.7% (N=4,675) of total visits. Two percent (N=6,005) of total visits and 65% (N=3,029) of all inpatient visits were prescribed opioid analgesics. Pain scores were available in 9% (N=23,455) of total visits, with patients reporting severe pain in 35% (N=8,205) of those visits. Three percent each of mild and moderate (N=242 and N=207, respectively), and 15% (N=1,118) of severe visits were prescribed opioid analgesics.

CONCLUSIONS : This retrospective analysis highlights opioid prescriptions even in mild and moderate pain, which may contribute to opioid dependence and ultimately addiction. More work needs to be done to promote multimodal therapy across the entire pain spectrum, reserving opioids for only the most intractable situations.