The Characteristics and Patterns of Analgesic use in Rheumatoid Arthritis

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The Characteristics and Patterns of Analgesic use in Rheumatoid Arthritis

Category:  16 RA‹clinical aspects

Frederick Wolfe1, Kaleb Michaud1, Jodi Messer2

1National Data Bank for Rheumatic Diseases, Wichita, KS;2Wichita State

University, Wichita, KS

Presentation Number: 863

Poster Board Number: 328

Keywords: Analgesics, rheumatoid arthritis

Background. Pain is a central dimension in rheumatic disease, and its

control a primary aim of therapy. In RA, pain control is most effectively

brought about by control of inflammation, but when inflammation control is

not complete, analgesics are sometimes used. Analgesic use is controversial,

and some believe that there is too much use while others believe there is

insufficient use. In spite of the importance of pain control and the

controversies surrounding analgesic use, there are no studies of analgesic

use in RA.

Objectives. To describe the prevalence and characteristics of analgesic use

in RA.

Methods. As part of a longitudinal outcome study of RA, 9,540 RA patients

were studied regarding details of analgesic use, as well as for other

clinical and treatment measures. This report details analgesic use other

than acetaminophen (APAP), which was used by 22.6% of RA patients.

Results. Overall, analgesics were used by 26.5%, with non-opiods accounting

for 16.4% and opiods for 10.1%. Users were slightly younger (60.1 v. 61.2

years), had earlier onset of RA (44.2 v. 47.5 years) and had longer duration

of disease (15.8 v. 13.5). Fewer men used analgesics (18.0% v. 25.7%) and

fewer users were high school graduates (87.0% v. 89.4%). Medicaid (public

assistance) was more common (8.5% v. 4.6%). Compared with those not using

analgesics, users had substantially more severe RA and RA consequences

(Table 1) including measures of work disability, joint arthroplasty, reduced

income, high direct medical costs, high scores for HAQ and pain, and

increased use of prednisone and TNF agents. In addition, 28.6% v. 11.1%

satisfied preliminary survey criteria for fibromyalgia. When opiod v.

non-opiod users were studied, more severe RA and symptoms were noted among

opiod users: HAQ 1.55 v. 1.39, pain 5.6 v. 4.9, % reporting disability 31.7%

v. 23.2%, direct medical costs $12,600 v. $10,060, fibromyalgia 34.2% v.

25.1%, but most other variables were similar for the 2 groups.

Conclusions. Analgesic use is common in RA and identifies patients with

active and severe RA. Analgesic users have high costs and service

utilization, and experience worse outcomes. Considering the high levels of

pain in analgesic users, studies should be done to determine if increased

analgesic use would benefit RA patients.

Variable Analgesic No Analgesic

Work disability (%) 22.1% 12.0%

Disabled (%) 26.5% 9.6%

Total Joint surgery (%) 16.9% 11.3%

Income $US $40,047 $46,295

Direct Costs (Yearly) $11,028 $6,852

HAQ (0-3) 1.45 0.92

Pain (0-10) 5.2 3.3

Prednisone (%) 44.4% 30.7%

TNF use 23.1% 16.3%