Patients with rheumatic diseases such as Rheumatoid Arthritis (RA), Psoriatic Arthritis (PsA), and Ankylosing Spondylitis (AS) are increasingly finding themselves reliant on long-term opioid use. This cycle often begins before they are even properly diagnosed, highlighting the critical need for more effective and tailored pain management strategies. Recent research published in Clinical Rheumatology underscores this growing issue, drawing attention to both the risks of opioid dependency and the missed opportunities for disease-modifying treatments.

Key Findings from the Study

In a study conducted by Jeffrey L. Stark, MD, vice president and head of medical immunology at UCB Pharma, researchers explored opioid use among patients with AS, PsA, and RA. The results showed a high rate of opioid use, not just around the time of diagnosis but persisting into long-term treatment. The study analyzed data from two large U.S. databases—Medicaid and IBM MarketScan—and found that many patients were prescribed opioids rather than receiving appropriate treatment for the underlying inflammatory conditions.

• Ankylosing Spondylitis (AS): Patients with AS demonstrated the highest rates of long-term opioid use compared to matched controls. Alarmingly, 30.6% of these patients had no claims for disease-modifying therapies, suggesting that many are relying on opioids without receiving adequate care for their condition.

• Psoriatic Arthritis (PsA) and Rheumatoid Arthritis (RA): Patients with PsA also showed significant opioid use, with a prevalence ratio of 2.21 (95% CI) when compared to controls. RA patients had a prevalence ratio of 1.98 (95% CI), and like their counterparts with AS and PsA, they also displayed long-term opioid reliance without corresponding claims for disease-modifying treatments. In RA patients, 65.4% had no claims for appropriate therapy.

Why This is a Dual Problem

Dr. Stark points out a critical dual problem in managing these rheumatic diseases. Not only does long-term opioid use pose risks like dependency and side effects, but it also delays the implementation of treatments that could potentially halt disease progression. The prioritization of pain management over inflammation control may, in fact, be exacerbating the conditions, leading to worse health outcomes for patients in the long run.

The Role of Disease-Modifying Therapies

Despite the clear need for disease-modifying antirheumatic drugs (DMARDs) to address the root causes of these conditions, many patients are not receiving them. Opioid use is often seen as a short-term solution to pain, but its overuse can mask the symptoms that should be managed with DMARDs and other anti-inflammatory treatments. This trend raises significant concerns about how healthcare systems are addressing pain in rheumatology patients, and whether opioid prescribing patterns reflect a deeper issue in access to proper care.

The Need for Better Education and Treatment Approaches

The findings of this study emphasize the necessity for better education, earlier diagnosis, and adherence to professional guidelines to ensure that patients with rheumatic diseases receive appropriate, long-term treatments. The focus should be on managing inflammation and disease progression rather than simply addressing pain with opioids.

Clinicians should be more proactive in offering and discussing alternatives to opioids, including the potential risks and benefits of DMARDs, biologics, and other therapies designed to target the underlying inflammation in these diseases.

Conclusion: Moving Beyond the Opioid Trap

The research highlights the complex challenges facing patients with AS, PsA, and RA when it comes to managing their pain and disease progression. Long-term opioid use not only risks dependency but also delays the necessary treatments that could improve overall patient outcomes. The American Arthritis Foundation is committed to raising awareness of these issues and advocating for improved treatment strategies that prioritize both effective pain relief and disease management.

By educating patients and healthcare providers, we can help break the cycle of opioid dependency and ensure that more patients receive the appropriate, life-altering treatments they need to control their rheumatic diseases.