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Chronic opioid use rises with obesity in rheumatoid arthritis

Key clinical point: Obesity was significantly associated with increased risk of incident chronic opioid use in rheumatoid arthritis patients.

Major finding: Over 93,254 person-years of follow-up, 2,802 adults with RA experienced an episode of chronic opioid use; the hazard ratio was 1.74 for overall use in those with a body mass index greater than 35 kg/m2, compared to individuals with a normal body mass index.

Study details: The data come from 19,794 adults with rheumatoid arthritis who were enrolled in a multipurpose rheumatic disease registry.

Disclosures: The study was supported in part by a Veterans Affairs Clinical Science Research & Development Merit Award to lead author Dr. Baker. Other authors reported funding from the Robert Wood Johnson Foundation, the Department of Veterans Affairs, the Rheumatology Research Foundation, and/or grants from and a grant from the National Institute of General Medical Sciences. The researchers had no financial conflicts to disclose.

Commentary

This study examines the incidence of chronic opioid use among participants in the Forward Registry, which follows patients with rheumatic diseases through questionnaires. Patients with RA were asked about use of opioid-based medications bi-annually; a higher rate of incident chronic opioid use was found among obese patients with RA. Factors other than obesity, such as pain and disability, accounted for part of this effect, and other potential factors including social and behavioral effects, were not examined. The authors suggest that obese patients may have a milder RA phenotype than non-obese patients. However, disease activity among participants is not known; thus, it may be that obese patients with RA had more active RA and thus more pain. The study does shine a light on avenues for future research, including risk factors for centralization of pain in RA, but does not yet support a causative association between obesity and opioid use in patients with RA.”

Arundathi Jayatilleke, MD

Lewis Katz School of Medicine, Temple University

Citation:

Baker JF et al. Arthritis Care Res. 2020 May 31. doi: 10.1002/ACR.24341.