Background/Purpose: Patients with psoriatic arthritis (PsA) or ankylosing spondylitis (AS) experience chronic pain due to inflammatory attributes of their disease. Nonsteroidal anti‑inflammatory drugs and biologics are recommended to improve symptoms, and biologics are recommended to inhibit disease progression. Many patients with chronic pain syndromes may receive opioid therapies; however, opioids do not treat underlying inflammation and are associated with adverse events. Limited data exist on the relationship between disease burden and opioid use in patients with PsA or AS. This study evaluated the association of patient‑reported outcome measures with opioid use and related costs in patients with PsA or AS from a national US registry.

Methods: This retrospective cohort study included adult participants enrolled in the FORWARD databank between July 2009 and June 2019. FORWARD is a longitudinal observational registry for rheumatic diseases that prospectively collects patient-reported data by questionnaires administered bi-annually. This sample included patients who completed ≥ 1 questionnaire from January 2010 to December 2019; patients had a physician-reported diagnosis of PsA or AS and responded to the Health Assessment Questionnaire Disability Index (HAQ-DI) or HAQ-DI and/or Bath Ankylosing Spondylitis Disease Activity Index (BASDAI; added in 2018), respectively. The primary outcomes were current opioid use and related costs at the time of the most recent questionnaire. The relationships between HAQ-DI or BASDAI and opioid use and related costs were assessed using logistic regression models for opioid use outcomes and generalized linear models with gamma distribution and log-link function for cost outcomes.

Results: This study included 828 patients with PsA and 334 patients with AS (Table 1). Overall, 177 patients with PsA (21.4%) and 91 with AS (27.3%) received opioids, with mean (SD) annualized related costs of $861 ($3669) and $1070 ($4617), respectively. There was a significant positive association (OR [95% CI]) between opioid use and HAQ-DI (1.99 [1.50-2.64] and 4.14 [2.59-6.63] in patients with PsA and AS, respectively; both P < 0.01) and BASDAI (1.22 [1.02-1.47] in patients with PsA; P < 0.05 and 1.94 [1.27-2.97] in patients with AS; P < 0.01). A 1-unit increase in HAQ-DI or BASDAI score was significantly associated (RR [95% CI]) with a 2.31 (1.40-3.81; P < 0.01) or 2.05 (1.09-3.86; P < 0.05) times increase, respectively, in opioid-related costs for patients with PsA, and a 17.82 (5.82‑54.51; P < 0.01) or 8.20 (1.15-58.59; P < 0.05) times increase, respectively, in opioid-related costs for patients with AS (Figure 1). Annualized average opioid use and costs increased with increasing HAQ-DI and BASDAI scores for patients in both cohorts (Figure 2).

Conclusion: Increased opioid use was associated with higher HAQ-DI and BASDAI scores among patients with PsA or AS. These findings suggest that, among patients with more severe disease, opioid use and related costs were numerically greater for patients with AS than patients with PsA.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/association-of-opioid-use-and-opioid-related-costs-with-patient-reported-outcomes-in-patients-with-psoriatic-arthritis-or-ankylosing-spondylitis/