Patients with inflammatory arthritis continue to be routinely prescribed analgesics in primary care, despite limited evidence of their effectiveness

Rheumatoid arthritis

A study published in the journal Rheumatology has found that patients with inflammatory arthritis (IA) in England continue to be routinely prescribed analgesics in primary care, with up to three-quarters of patients receiving a prescription for an analgesic per calendar year. Furthermore, at least one in three patients involved in the study were receiving long-term opioid prescriptions.

IA, which encompasses several autoimmune joint inflammation disorders, affects about one in 100 people in England. Pain management remains a major challenge for these patients. Although evidence from systematic reviews has shown analgesics to have a limited impact on pain in IA, global data indicate widespread use of analgesics, including opioids.

Study details 

Researchers at Keele University assessed the annual frequency of analgesic prescriptions in patients with IA (rheumatoid arthritis [RA], psoriatic arthritis [PsA], and axial spondyloarthritis [SpA]) and matched controls without IA, identified from the Consultations in Primary Care Archive (2000–2015).

Analgesic prescriptions were categorised as basic, opioids, gabapentinoids, and oral nonsteroidal anti-inflammatory drugs (NSAIDs), and further sub-categorised on the basis of chronicity as intermittent (one to two prescriptions per calendar year) and chronic (three or more prescriptions per calendar year).

Across the study period, a significantly higher proportion of patients with IA (66.8–78.5%) were prescribed analgesics compared with controls (37.5–41.1%). Despite a decline in opioid prescribing among patients with IA between 2000 and 2015, 45.4% (95% confidence interval [CI] 42.4–48.4%) of patients received at least one opioid prescription and 32.9% (95% CI 29.8–36.0%) received three or more opioid prescriptions in 2015.

Lead author Dr Ian Scott, Consultant Rheumatologist and Honorary Senior Lecturer at Keele University’s School of Medicine, said: ‘Our study has shown there is substantial and sustained prescribing of pain medicines, particularly of opioids, to patients with inflammatory arthritis in the English NHS. As there is generally only limited evidence that pain medicines may help inflammatory arthritis pain in some patients, but substantial evidence they can cause harm, this finding is concerning.’

The annual frequency of gabapentinoid prescriptions grew from 2.0% in 2007 to 9.5% in 2015 among patients with IA, compared with a corresponding growth from 1.2% to 4.7% among controls. Conversely, the annual frequency of oral NSAID prescriptions declined from 53.7% in 2000 to 25.0% in 2015 among patients with IA, and from 11.9% to 6.8% among controls.

Over the entire study duration, analgesic prescribing was more common in patients with RA than in those with PsA or axial SpA.

Redefining treatment strategies 

‘There is an urgent need for interventions to deliver safer analgesic prescribing in this patient population. The crucial first step towards developing such interventions is to understand what drives clinician analgesic prescribing and patient analgesic use in IA’, the authors said.

Dr Scott also emphasised shifting the approach from long-term analgesic prescribing to alternative treatment strategies. ‘There are many other ways to help patients with inflammatory arthritis manage their pain. These include reducing joint inflammation using specialist disease-modifying medicines, exercise, and talking therapy treatments’, he said.

This article originally appeared on Medscape, part of the Medscape Professional Network.

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