We retrospectively assessed the long term efficacy and safety of opioids in older persons with rheumatoid arthritis(RA. We included RA patients aged ≥60 years who received opioids based on moderate-severe numerical pain scores (NPS 0-10 scale) of ≥5. Efficacy measures at immediate and last follow-ups were ≥30% improvement in pain (NPS30), ≥0.22 improvement in physical function by health assessment questionnaire (HAQ-DI) and ≥50% improvement in clinical disease activity index (CDAI50). Safety outcomes include discontinuations from serious events and abnormalities in creatinine/transaminases and reports of misuse/diversion. Of 20 patients, 16 (80%) were women. Mean age was 69.9 ± 5.1 years and disease duration 10.6 ± 8.6 years. Mean baseline scores were 7.2 ± 2.1 for NPS(0-10),1.19 ± 0.8 for HAQ-DI(0-3)and 25.8 ± 12.6 for CDAI(0-76). Five patients (25%) received Schedule II short-acting morphine, oxycodone ± acetaminophen, 1(5%)got Schedule II long-acting morphine, oxycodone or fentanyl plus Schedule III/IV-hydrocodone, tramadol or codeine, 3 (15%) received Schedule II long-acting plus short-acting and 11 (55%) received Schedule III/IV only. 16(80%) patients received a total daily dose of ≤120 mg morphine equivalents while 4 (20%)had ≥120 mg. At 1)immediate (mean 4 ± 2 months) and 2)last (Median 11 months; range 6-71) follow-ups, NPS30 was achieved in 8/19 (42%) and 9/19 (47%), HAQ-DI 0.22 in 4/15 (27%) and 5/14 (46%) and CDAI50 in 1/19 (5.2%) and 1/18 (5.5%) respectively. Oxycodone achieved NPS30 in 5/7 (71.4%) patients . One serious event of intestinal obstruction in a diabetic on fentanyl-oxycodone regimen was noted. Misuse, diversion or creatinine/transaminase abnormalities were not detected. Responders had worse baseline pain versus non-responders(8.6 ± 1.8 vs. 6.2 ± 1.8;p=.008). In this older RA cohort, opioids- particularly oxycodone-effectively improved pain and physical function. We retrospectively assessed the long term efficacy and safety of opioids in older persons with rheumatoid arthritis(RA. We included RA patients aged ≥60 years who received opioids based on moderate-severe numerical pain scores (NPS 0-10 scale) of ≥5. Efficacy measures at immediate and last follow-ups were ≥30% improvement in pain (NPS30), ≥0.22 improvement in physical function by health assessment questionnaire (HAQ-DI) and ≥50% improvement in clinical disease activity index (CDAI50). Safety outcomes include discontinuations from serious events and abnormalities in creatinine/transaminases and reports of misuse/diversion. Of 20 patients, 16 (80%) were women. Mean age was 69.9 ± 5.1 years and disease duration 10.6 ± 8.6 years. Mean baseline scores were 7.2 ± 2.1 for NPS(0-10),1.19 ± 0.8 for HAQ-DI(0-3)and 25.8 ± 12.6 for CDAI(0-76). Five patients (25%) received Schedule II short-acting morphine, oxycodone ± acetaminophen, 1(5%)got Schedule II long-acting morphine, oxycodone or fentanyl plus Schedule III/IV-hydrocodone, tramadol or codeine, 3 (15%) received Schedule II long-acting plus short-acting and 11 (55%) received Schedule III/IV only. 16(80%) patients received a total daily dose of ≤120 mg morphine equivalents while 4 (20%)had ≥120 mg. At 1)immediate (mean 4 ± 2 months) and 2)last (Median 11 months; range 6-71) follow-ups, NPS30 was achieved in 8/19 (42%) and 9/19 (47%), HAQ-DI 0.22 in 4/15 (27%) and 5/14 (46%) and CDAI50 in 1/19 (5.2%) and 1/18 (5.5%) respectively. Oxycodone achieved NPS30 in 5/7 (71.4%) patients . One serious event of intestinal obstruction in a diabetic on fentanyl-oxycodone regimen was noted. Misuse, diversion or creatinine/transaminase abnormalities were not detected. Responders had worse baseline pain versus non-responders(8.6 ± 1.8 vs. 6.2 ± 1.8;p=.008). In this older RA cohort, opioids- particularly oxycodone-effectively improved pain and physical function.