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Opioid Analgesic Use in Patients with Ankylosing Spondylitis: An Analysis of the Prospective Study of Outcomes in an Ankylosing Spondylitis Cohort.

Authors
  • Dau, Jonathan D1, 2
  • Lee, MinJae1, 2
  • Ward, Michael M1, 2
  • Gensler, Lianne S1, 2
  • Brown, Matthew A1, 2
  • Learch, Thomas J1, 2
  • Diekman, Laura A1, 2
  • Tahanan, Amirali1, 2
  • Rahbar, Mohammad H1, 2
  • Weisman, Michael H1, 2
  • Reveille, John D3, 4
  • 1 From the Department of Internal Medicine, Division of Rheumatology, and the Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston, Houston, Texas; National Institute of Arthritis and Musculoskeletal and Skin Diseases, US National Institutes of Health, Bethesda, Maryland; Department of Medicine, Division of Rheumatology, University of California San Francisco (UCSF), San Francisco, California, USA; University of Queensland Diamantina Institute, Translational Research Institute, and Institute of Health and Biomedical Innovation, Queensland University of Technology, Princess Alexandra Hospital, Queensland, Australia; Division of Rheumatology, Cedars Sinai Medical Center, Los Angeles, California, USA. , (Australia)
  • 2 J.D. Dau, MD, Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center Houston; M.J. Lee, PhD, Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston; M.M. Ward, MD, MPH, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health; L.S. Gensler, MD, Department of Medicine, Division of Rheumatology, UCSF; M.A. Brown, FRACP, University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital, and Institute of Health and Biomedical Innovation, Queensland University of Technology, Translational Research Institute, Princess Alexandra Hospital; T.J. Learch, MD, Division of Rheumatology, Cedars Sinai Medical Center; L.A. Diekman, MS, Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center Houston; A. Tahanan, BS, Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston; M.H. Rahbar, PhD, Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston; M.H. Weisman, MD, Division of Rheumatology, Cedars Sinai Medical Center; J.D. Reveille, MD, Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center Houston.
  • 3 From the Department of Internal Medicine, Division of Rheumatology, and the Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston, Houston, Texas; National Institute of Arthritis and Musculoskeletal and Skin Diseases, US National Institutes of Health, Bethesda, Maryland; Department of Medicine, Division of Rheumatology, University of California San Francisco (UCSF), San Francisco, California, USA; University of Queensland Diamantina Institute, Translational Research Institute, and Institute of Health and Biomedical Innovation, Queensland University of Technology, Princess Alexandra Hospital, Queensland, Australia; Division of Rheumatology, Cedars Sinai Medical Center, Los Angeles, California, USA. [email protected] , (Australia)
  • 4 J.D. Dau, MD, Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center Houston; M.J. Lee, PhD, Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston; M.M. Ward, MD, MPH, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health; L.S. Gensler, MD, Department of Medicine, Division of Rheumatology, UCSF; M.A. Brown, FRACP, University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital, and Institute of Health and Biomedical Innovation, Queensland University of Technology, Translational Research Institute, Princess Alexandra Hospital; T.J. Learch, MD, Division of Rheumatology, Cedars Sinai Medical Center; L.A. Diekman, MS, Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center Houston; A. Tahanan, BS, Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston; M.H. Rahbar, PhD, Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston; M.H. Weisman, MD, Division of Rheumatology, Cedars Sinai Medical Center; J.D. Reveille, MD, Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center Houston. [email protected]
Type
Published Article
Journal
The Journal of rheumatology
Publication Date
Feb 01, 2018
Volume
45
Issue
2
Pages
188–194
Identifiers
DOI: 10.3899/jrheum.170630
PMID: 29196383
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Opioid analgesics may be prescribed to ankylosing spondylitis (AS) patients with pain that is unresponsive to antirheumatic treatment. Our study assessed factors associated with opioid usage in AS. A prospective cohort of 706 patients with AS meeting modified New York criteria followed at least 2 years underwent comprehensive clinical evaluation of disease activity and functional impairment. These were assessed by the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Bath Ankylosing Spondylitis Functional Index (BASFI). Radiographic severity was assessed by the Bath Ankylosing Spondylitis Radiology Index and modified Stokes Ankylosing Spondylitis Scoring System. Medications taken concurrently with opioids, as well as C-reactive protein (CRP) levels and erythrocyte sedimentation rate (ESR), were determined at each study visit, performed every 6 months. Analyses were carried out at baseline, and longitudinal multivariable models were developed to identify factors independently associated with chronic and intermittent opioid usage over time. Factors significantly associated with opioid usage, especially chronic opioid use, included longer disease duration, smoking, lack of exercise, higher disease activity (BASDAI) and functional impairment (BASFI), depression, radiographic severity, and cardiovascular disease. Patients taking opioids were more likely to be using anxiolytic, hypnotic, antidepressant, and muscle relaxant medications. Multivariable analysis underscored the association with smoking, older age, antitumor necrosis factor agent use, and psychoactive drugs, as well as with subjective but not objective determinants of disease activity. Opioid usage was more likely to be associated with subjective measures (depression, BASDAI, BASFI) than objective measures (CRP, ESR), suggesting that pain in AS may derive from sources other than spinal inflammation alone.

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