Background/Purpose:

The Health and Human Services has declared the opioid epidemic as a public health emergency. It has been demonstrated that even short exposures to opioids could progress to episodic and ultimately long-term opioid use. Acute gout is among the most painful inflammatory arthritis. However, the burden of opioid use in acute gout has not been previously evaluated. Our aim was to assess the use of prescription opioids among patient discharged from the hospital with acute gout and factors associated with it.

Methods:

Lifespan healthcare system, the largest in Rhode Island, comprises of 3 acute-care facilities with emergency departments (ED) and outpatient centers. Adult gout patients (greater than 18 years) discharged from the ED or inpatient facility were identified using ICD-9 and ICD-10 codes from the electronic health records. We included all patients seen between March 2015 and Sept. 2017. If a single patient was seen multiple times, only the first encounter was included.

Outcome of interest was prescription opioid given at discharge from ED/inpatient stay. We collected information regarding patient demographics, comorbidities including history of chronic pain and substance abuse, prior to admission opioid use and time of presentation to ED. Information regarding single versus multiple joint involvement and severity of disease as assessed by the triage nurse on ED severity scale (1 being the most severe and 5 being least) was also abstracted. A multivariable logistic regression was used to assess factors associated with the use of prescription opiates at discharge from the hospital.

Results: A total of 456 patients (mean age 58.7±16.4 years, 79% male) were treated for acute gout in the ED of which 11.2% were hospitalized. A total of 129 patients (28.3%) received prescription opioid at discharge. Of these, 102 (79%) patients were not on opioids at admission. In a multivariable model, diabetes [aOR 2.02 (1.13—3.59)], prescription opioid use at admission [aOR 2.1 (1.01—4.34)] and having a polyarticular gout attack [aOR 2.58 (1.33—4.99)] were associated with increased odds of prescription opioid use at discharge.

Conclusion: Despite the availability of effective treatments, opioids are commonly used for management of acute gout, even in patients who are not present on it at admission. Fear of steroid use in diabetics could have led to increased reliance on opioids. Similarly, polyarticular involvement led to increased use of opioids. The study highlights an opportunity to curb the opioid epidemic among acute gout patients.

« Back to 2018 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/opioid-analgesic-use-in-acute-gout-patients-discharged-from-the-hospital/