Session Information
Session Type: Abstract Submissions (ACR)
Background/Purpose: Prescription opiates are commonly prescribed in patients with chronic pain, yet there is no evidence that these drugs ameliorate disease progression, and are associated with numerous side effects, including dependence and overdosage. The purpose of this study was to assess factors associated with narcotics usage in AS patients.
Methods: 611 AS patients, meeting the modified New York criteria followed up to 4 years and enrolled in a longitudinal outcome study were assessed. Demographic, clinical and self-reported outcomes were collected every 4-6 months. Usage of medications since last visit was collected every visit, including daily dosage, how many days in the prior month taken and how many months since the previous visit. Disease activity was defined by the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), functional outcomes by the Bath Ankylosing Spondylitis Functional Index (BASFI) and radiographic severity by the Bath Ankylosing Spondylitis Radiographic Index (BASRI) and the modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS). Depression was gauged by self-report, by the use of anti-depressant medications, and by Center for Epidemiologic Studies Depression Scale (CES-D) testing. Univariable mixed models were used to identify factors associated with narcotic usage accounting for correlation of repeated measures over time. Final longitudinal multivariable models were developed that identified independent factors associated with narcotic usage.
Results: The cohort was 71% male and 76% of patients were white, having a mean age 41.1 years (SD= 13.6). Mean disease duration was 17.6 years (SD=13.5). Opiate usage was reported in 87 (14.3%) of patients (9.36% taking continuously, 4.96% intermittently). Table 1 shows the univariable associations between narcotics usage and each independent variable from longitudinal model. Independent factors associated with narcotic usage in the multivariable analysis included subjective disease activity (measured by the BASDAI, OR=2.9, 95% CI=(1.8, 4.7), p<0.0001), functional impairment (measured by the BASFI, OR=1.9, 95% CI=(1.1, 3.15), p=0.023), depression (OR=2.3, 95% CI=(1.12 4.7), p=0.015) and the use of muscle relaxants (OR=5.3 , 95% CI=(2.6, 10.7), p<0.0001). Complex interrelationships were encountered between depression, anti-depressives and other medications (anxiolytics and muscle relaxants).
Conclusion: AS patients using opiates have significantly greater subjective disease activity, report greater functional impairment, exhibit more depression and are more likely to take muscle relaxants than those that do not.
|
Table 1 Univariable Association Between Narcotics Usage And Other Selected Variables |
|
Variable |
OR |
95% CI |
P |
|
Male gender |
0.647 |
(0.389,1.075) |
0.093 |
|
White |
2.010 |
(1.113,3.63) |
0.021 |
|
Smoking (present or prior) |
2.125 |
(1.324,3.409) |
0.0018 |
|
Age > 40 years |
1.853 |
(1.154,2.974) |
0.011 |
|
Patient employed |
3.352 |
(1.999,5.622) |
<0.0001 |
|
Depression (self report) |
5.907 |
(3.33,10.478) |
<0.0001 |
|
High blood pressure |
2.186 |
(1.23,3.885) |
0.0077 |
|
Elevated ESR |
1.285 |
(0.89,1.855) |
0.18 |
|
Patient Global Pain assessment |
4.240 |
(2.866,6.274) |
<0.0001 |
|
Concomitant use of Prednisone |
2.996 |
(1.345,6.675) |
0.0073 |
|
Concomitant use of TNFi Agents |
1.526 |
(0.997,2.336) |
0.0514 |
|
Concomitant use of anti-depressants |
2.601 |
(1.504,4.498) |
0.0006 |
|
Concomitant use of anxiolytics |
8.042 |
(3.384,19.114) |
<0.0001 |
|
Concomitant use of muscle relaxants |
8.458 |
(4.913,14.562) |
<0.0001 |
|
Radiographic severity (mSASSS) |
1.236 |
(0.747,2.043) |
0.41 |
|
Depression (Elevated CES-D ) |
3.071 |
(2.078,4.539) |
<0.0001 |
|
Disease activity (BASDAI > 4) |
5.460 |
(3.707,8.043) |
<0.0001 |
|
Impaired function (BASFI ) |
4.323 |
(2.857,6.543) |
<0.0001 |
|
Exercise 3 times or more per week |
0.805 |
(0.569,1.14) |
0.22 |
Disclosure:
J. D. Reveille,
None;
M. M. Ward,
None;
M. Lee,
None;
M. Rahbar,
None;
M. Ardjomand-Hessabi,
None;
L. A. Diekman,
None;
M. A. Brown,
None;
L. S. Gensler,
None;
M. H. Weisman,
ACR/EULAR,
2,
ACR,
2,
Rigel,
2,
SanofiAventis,
2,
NIH,
2,
FDA,
2,
Cedars-Sinai Medical Center,
3,
UCB,
5.
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