Tramadol use increases mortality and risk of major adverse cardiovascular events in rheumatoid arthritis patients: evidence from a population-based cohort study.

Abstract

With great interest, we studied the research conducted by Dr Nalini and colleagues. With a population-based cohort, the present study evaluated a great amount of individuals and provided an important evidence about the association between long-term opiate use and cardiovascular death.1 However, since opioid use was of high rate prescribed in patients with rheumatoid arthritis (RA) and osteoarthritis, we believe that the scope could be extended to the field of rheumatic diseases. Moreover, the association between opiate use and other related outcomes such as major adverse cardiovascular events (MACE) and overall mortality, were also worth of being evaluated. To clarify the issue, we designed a population-based retrospective cohort study to evaluate the influence of tramadol to subsequent MACE risk and mortality in RA patients. As a weak opioid agonist, tramadol has been commonly utilized in pain management, especially in patients with chronic pain conditions. Clinically, previous study indicated that opioid use was of high rate in patients with RA, and tramadol was one of the most utilized opioid agonists (71.1%).2 Previous studies evaluating severe adverse effect of tramadol faced strong limitation of small sample size, which could possibly cause lower evidence power.3,4 Two clinical trials with small sample size reported tramadol users not showing significantly higher risk in myocardial injury or adverse events in cardiovascular system, comparing with non-tramadol users.5 Large-scale study evaluating the risk of MACE and overall morality in tramadol users with RA is currently lacking.