Background/Purpose:   Chronic pain is one of the most common symptoms reported in patients with SLE. Treating pain in these individuals can be complex and difficult to manage and often require opioid therapy. The present research, to our knowledge, is the first investigation into the impact of opioid use in the management of patients with SLE and chronic pain.

Methods:   This prospective 5 year longitudinal outcome study of 275 SLE patients at the University of New Mexico included 24% (chronic opioid use) and 76% (no opioid use). Inclusion criteria were patients fulfilling ACR criteria for SLE, aged18-80. Patients diagnosed with any other autoimmune disease were excluded. Outcomes were determined at 5 years after enrollment in the study. Statistical differences were determined with Student t-test and categorical data with Fisher’s exact method. Associations were determined initially with univariate regression analysis and then multivariate models were created to determine independent and dependent variables.

Results:   No statistical signficance was observed in age, age of onset, disease duration, race, family history of autoimmune disease, alcohol use, ANA titer, dsDNA titer, aPL positivity, anti-ribosomal P, RNP, anti-Smith, Ro/SSA, La/SSB, Scl-70, Coombs, active or chronic kidney disease, or joint pain between opioid and non-opioid SLE groups. SLE patients that used opioids had a signficantly higher rate of tobacco use and duration, criteria average for SLE diagnosis, average pain scores, morning stiffness, SLICC and SLEDAI indices, cocaine use, non-compliance, and total deaths. Logistic regression analysis predicting death revealed hazard ratios 2.6 and 1.1, when comparing opioid use and total SLEDAI respectively; and hazard ratios 2.5, 1.1, and 1.6, when comparing opiod use, total SLEDAI, and non-compliance respectively. Univariate Cox Model estimated the probability of death in SLE patients revealed statistical significance for opioid use and non-compliance, hazard ratios 3.2 and 1.8 respectively. Multivariate Cox Model analysis estimating the probability of death with covariates; opioid use and total SLEDAI (both statistically significant, hazard ratios 2.6 and 1.1 respectively), opioid use and alcohol use (only opioid use was statistically significant, hazard ratio 3.3), opioid use, cocaine use, and alcohol use (only opioid use and cocaine use were statistically significant, hazard ratios 3.0 and 3.2 respectively), and lastly opioid use, non-compliance, and total SLEDAI (only opioid use and non-compliance were statistically significant, hazard ratios 2.5 and 1.1 respectively). The marginal survival for SLE patients not taking opioids was 88% (12% dead) versus 65% (35% dead) patients taking opoiods. The Kaplan-Meir survival curve revealed higher probability of survival for SLE patients that did not use opioids.

Conclusion:   This study indicates that opioid use in SLE is associated with higher mortality, total SLICC and SLEDAI disease activity scores, increase cocaine use, and non-compliance. These data suggest the need for education and safe opioid prescribing strategies in SLE patients with chronic pain.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/opiod-use-and-death-in-chronic-pain-patients-with-systemic-lupus-erythematosis/