Analgesics are Commonly Prescribed for Inflammatory Arthritis Despite Little Benefit

Pavankumar Kamat

January 25, 2022

A study published in journal  Rheumatology  examines how 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 1 in 3 patients were receiving a long-term opioid prescriptions.

Inflammatory arthritis, which includes several autoimmune joint inflammation disorders, affects about 1 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 indicates a widespread use of analgesics, including opioids.

Study Details

Researchers at Keele University assessed the annual prevalence 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/calendar year) and chronic (three or more prescriptions/calendar year).

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

Lead author Dr Ian Scott, consultant rheumatologist and honorary senior lecturer from 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 prevalence 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. On the other hand, the annual prevalence 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.

The research was supported by grants from the National Institute for Health Research. Christian Mallen reported supporting Bristol Myers Squibb in patient recruitment for a different trial. The remaining authors declare no conflicts of interest.

Scott IC, Bailey J, White C, Mallen CD, Muller S. Analgesia Prescribing in Patients with Inflammatory Arthritis in England: An Observational Study Using Electronic Healthcare Record Data. Rheumatology (Oxford). 2021 Nov 24 [Epub ahead of print]. doi: 10.1093/rheumatology/keab870. PMID: 34849617. Full text

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