Factors related to the use of opioids as early treatment in patients with knee osteoarthritis

Soo-Kyung Cho,Hyoungyoung Kim,Eun Jin Jang,Woo Seok Choi,Seongmi Choi,Seul Gi Im,Sun-Young Jung,Yoon-Kyoung Sung

doi:10.1186/s13075-019-2004-x

Abstract

ObjectiveTo examine factors related to the use of opioids as an early treatment option for knee OA patientsMethodsUsing the Korean nationwide claim database, we selected knee OA patients between 2013 and 2015. Among them, patients without any claim of knee OA for 2 years before the index date were included as our study population. We analyzed their first claim for prescriptions, including tramadol and stronger opioids, at the index date of each patient. Using a multinomial model, we identified factors associated with the early use of tramadol and stronger opioids in knee OA patients.ResultsAmong a total of 2,857,999 knee OA patients, 12.2% (n = 348,516) were treated with opioids as their first treatment. However, the prevalence of stronger opioid use was only 0.07% (n = 1972). Male sex (OR 1.28 in tramadol, OR 1.13 in stronger opioids) and comorbidities with depression (OR 1.05, 1.46), low back pain (OR 1.13, 1.30), intervertebral disc disorder (OR 1.11, 1.40), and spinal stenosis (OR 1.27, 1.55) were the factors for the early use of tramadol or stronger opioids in knee OA patients. Patients in a tertiary referral hospital tended to use tramadol or stronger opioids than those in clinics (OR 1.04, 56.63, respectively).ConclusionIn Korea, 12.2% of knee OA patients were treated with opioids as an early treatment, and tramadol was used more commonly than stronger opioids. Male sex and having comorbidities such as depression or musculoskeletal disease are patient factors associated with the early use of opioids in knee OA patients.

Highlights

Osteoarthritis (OA) is a highly prevalent, chronic condition affecting nearly 25% of adults aged 55 years and older in the United States (US) [1], and its prevalence continues to rise [2]
When we compared patient characteristics according to the early use of opioids, opioid users were slightly older (64.2 vs. 64.0 years old, p < 0.01) and more likely to be male (44.0% vs. 37.8%, p < 0.01) than opioid nonusers
The Elixhauser comorbidity index score was higher in opioid users than opioid non-users (4.51 ± 6.36 vs. 4.43 ± 6.23, p < 0.01)

Summary

Introduction

Osteoarthritis (OA) is a highly prevalent, chronic condition affecting nearly 25% of adults aged 55 years and older in the United States (US) [1], and its prevalence continues to rise [2]. Over the past two decades, the increasing use of opioids for chronic musculoskeletal pain in the US [10] and Europe [11] has been a serious public health problem. A. Cho et al Arthritis Research & Therapy (2019) 21:222 study using the Medicare Current Beneficiary Survey in the US showed that there was a significant increase in opioid prescribing between 2003 and 2009, resulting in 40% of knee OA patients receiving an opioid in 2009 [12]. A more recent study from 2007 to 2014 showed that 15.9% of patients with knee OA were prescribed opioids for their condition and that yearly rates of prescription were fairly stable over this period [13]. A recent study in the US revealed substantial statewide variation in the prescription of opioids in OA patients [19]

Methods

Results

Discussion

Conclusion