Abstract
The objective was to determine the trend in the use of opioid analgesics in a cohort of patients diagnosed with and treated for rheumatoid arthritis (RA) in 24 cities in Colombia. This retrospective cohort study included adult patients diagnosed with RA, which was managed in a specialized institution in Colombia between January 2011 and December 2012. The first rheumatology visit was recorded as an index date, and monthly monitoring of the analgesic medication received was performed until December 2017. Sociodemographic variables, the use of opioids, and concomitant prescriptions were evaluated. A total of 1,329 patients diagnosed with and treated for RA were included; they had a mean age of 61.2 ± 11.8 years and were predominantly females (n = 936; 82.9%). A total of 1,129 (84.9%) subjects used opioids for at least one month, and a growing trend, from 13.5% to 21.4%, was observed in patients who received opioids every month throughout a 7-year follow-up of the cohort. In total, 46.7% of the cases used opioids for more than 12 months. The most commonly used opioids were codeine (76.3%) and tramadol (71.1%). All patients received conventional disease-modifying antirheumatic drugs (DMARDs), 85.6% received systemic corticosteroids, 73.9% received nonsteroidal anti-inflammatory drugs, and 15.9% received biological DMARDs. A high proportion of opioid use was shown for pain management in patients with RA, in many cases for more than 12 months, in whom the efficacy and especially safety, related to the risk of dependence, should be monitored.
Highlights
Rheumatoid arthritis (RA) affects the adult population, with an estimated prevalence between 0.5% and 1% and an incidence of 5–50 per 100,000 population, mainly affecting women over 65 years
An observational retrospective cohort study was conducted, which included all patients with diagnosis of rheumatoid arthritis (RA), according to the codes of the International Classification of Diseases version 10.0 (ICD-10), and older than 18 years treated with conventional or biological disease-modifying antirheumatic drugs (DMARDs) at the Specialized Healthcare Provider Institution (Institucion Prestadora de Servicios Especializada, IPS-E) in 24 cities in Colombia (Ithe rheumatologists of IPS Especializada, use EULAR criteria for the diagnosis of RA), who were affiliated with seven different insurers or EPS (Entidades Promotoras de Salud)
We identified 416 patients (36.8%) who used a single opioid analgesic during the observation period, 434 (38.4%) who used two different opioids, 229 (20.3%) with three opioids, and 43 (3.8%) who received up to four different opioids. e most used opioids were codeine and tramadol; Table 2 shows the prescription patterns for the opioid analgesics used
Summary
Rheumatoid arthritis (RA) affects the adult population, with an estimated prevalence between 0.5% and 1% and an incidence of 5–50 per 100,000 population, mainly affecting women over 65 years. For the treatment of pain caused by the RA activity, there are multiple classes of drugs, such as opioids. Recent studies have shown an increase in opioid use, mainly in the first group [10, 11]. The latter group presents an increased risk of long-term use, situation that can lead to related problems such as dependency, addiction, and overdose, as well as an increased risk of death in this population; the need to rationalize
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