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Do subjective components of disease activity contribute to heterogeneity in opioid prescriptions in inflammatory rheumatic diseases? Results from ESPOIR and DESIR cohorts


1, 2, 3, 4, 5, 6, 7

 

  1. Clinical Epidemiology Applied to Rheumatic and Musculoskeletal Diseases, Université Paris Cité, Inserm U1153, Paris; and Epidemiology of Ageing and Neurodegenerative Diseases, Université Paris Cité, Inserm U1153, Paris, France. sushmithadev.kumaradev@inserm.fr
  2. Clinical Epidemiology Applied to Rheumatic and Musculoskeletal Diseases, Université Paris Cité, Inserm U1153, Paris; and Department of Rheumatology, APHP-Centre, Cochin Hospital, Paris, France.
  3. Department of Rheumatology, APHP, Sorbonne Université, Inserm UMRS_938, Saint-Antoine Hospital, Paris, France.
  4. Pain Clinic, APHP-Centre, INSERM U897, Cochin Hospital, Paris, France.
  5. Department of Rheumatology, APHM, Sainte-Marguerite Hospital, Aix-Marseille University, Marseille, France.
  6. Clinical Epidemiology Applied to Rheumatic and Musculoskeletal Diseases, Université Paris Cité, Inserm U1153, Paris; and Department of Rheumatology, APHP-Centre, Cochin Hospital, Paris, France.
  7. Epidemiology of Ageing and Neurodegenerative Diseases, Université Paris Cité, Inserm U1153, Paris, France.

CER16879
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PMID: 38019160 [PubMed]

Received: 01/06/2023
Accepted : 18/09/2023
In Press: 29/11/2023

Abstract

OBJECTIVES:
To determine whether subjective components of disease activity are associated with heterogeneity in opioid prescription in inflammatory rheumatic diseases (IRDs) after accounting for objective inflammatory markers.
METHODS:
Data from two prospective observational cohorts of early IRDs (ESPOIR for rheumatoid arthritis (RA) and DESIR for spondyloarthritis (SpA)) were included. Opioid prescription duration (converted to monthly binary opioid prescription), disease activity (Disease activity score 28 (DAS28) for RA; Axial spondyloarthritis disease activity score-C-reactive protein (ASDAS-CRP) for SpA) and its components were measured respectively at 13 and 9 occasions spanning 10- and 6-years of follow-up. Group-based trajectory modelling defined opioid-prescription trajectories and mixed-models characterised the evolution of disease activity and its subjective components by opioid-prescription trajectories.
RESULTS:
Four distinct opioid-prescription trajectories: no/low (60.5% and 54.3%), declining (14.7% and 15.8%), augmenting (11.9% and 10.7%), and persistent (12.9% and 19.1%) were identified in RA and SpA respectively (60% were prescribed opioids at least once). Those with regular opioid prescriptions (up to 30%) are often older, less educated, have higher BMI and worse disease. No/low trajectory was the reference for examining evolution of disease activity and subjective components (n=810 RA, n=679 SpA). In IRDs, consistently higher disease activity throughout follow-up were seen with persistent (DAS28(β=0.4–0.8); ASDAS-CRP(β=0.4–0.6)), and augmenting (DAS28(β=0.2–0.5); ASDAS-CRP(β=0.3–0.6)) trajectories and until 3- or 4-years of follow-up (DAS28(β=0.3–0.4); ASDAS-CRP(β=0.2–0.3)) with declining trajectory. Like-wise, despite accounting for objective inflammation, subjective components had worse scores over follow-up in augmenting and persistent trajectory.
CONCLUSIONS:
Non-inflammatory pain mechanisms amplify subjective outcomes, thus, worsening composite measures like disease activity.

DOI: https://doi.org/10.55563/clinexprheumatol/nq59pt

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