Background/Purpose: Idiopathic inflammatory myopathies (IIM) can be associated with significant pain and functional impairment. While the use of opioids has been documented in other inflammatory disorders, data regarding opioid use in patients with IIM are scarce. Given the risks of long-term opioid therapy, understanding the prevalence and predictors of chronic opioid requirements in this patient population is crucial for developing appropriate pain management strategies.

Methods: We used the FORWARD Databank – a longitudinal prospective registry of adults with rheumatic diseases in the US. Participants included in this study had a physician diagnosis of IIM and completed comprehensive semiannual questionnaires reporting sociodemographic features, pain, fatigue, physical function, disease activity, use of opioids/other medications, and health services at serial visits. Chronic opioid use was defined as documentation of opioid use in participant surveys on ≥2 consecutive study visits, amounting to a cumulative duration of opioid use of ≥ 90 days. Fischer’s exact and Student’s T tests were used to compare healthcare utilization, satisfaction, and outcomes between participants with and without chronic opioid use. The observation at enrollment was used for non-chronic opioid users while the first-reported opioid use observation was used for chronic opioid users. Logistic regression was used to determine variables associated with chronic opioid use. We calculated the annual prevalence and temporal trends of opioid use among participants with at least 90 days of follow-up defining use as documentation of opioid use at ≥1 visit within a given year between years of 2004-2023.

Results: Out of 210 participants with IIM, 152 (mean age ± SD, 55.4 ± 1.4, 80.5% female, and 85.8% White) with at least 90 days of follow-up were included. The participants were followed for a mean duration of 4.9 ± 0.4 years. A total of 43 participants with IIM (28.3%) were found to have chronic (90+ days) opioid use. Participants with chronic opioid use were more likely to have history of smoking, non-White race, lower annual income, and were more likely to have comorbid depression, fibromyalgia, pulmonary and gastrointestinal disorders, with a higher rheumatic disease comorbidity index. Chronic opioid use was associated with worse fatigue, pain, patient global disease activity, disability, and quality of life (Table 1). On multivariable logistic regression, history of smoking and presence of comorbid pulmonary disease were significantly associated with increased odds of chronic opioid use (Table 2). The prevalence of opioid use was relatively stable at 20% – 33% between 2004 and 2017 with a downward trend between 2017-2023 (Figure 1).

Conclusion: Approximately one in three individuals with IIM are chronic opioid users. Smoking history, comorbid pulmonary disease, and poor health-related outcomes are associated with chronic opioid use among individuals with IIM. Further studies evaluating pain mechanisms and alternate pain management strategies in IIM patients are needed.

Table 1. Health-related outcomes, satisfaction, and health care utilization of FORWARD participants with IIM with and without chronic opioid use.

Table 2. Factors associated with chronic opioid use among individuals with IIM on univariable and multivariable logistic regression models.

Figure 1. Annual prevalence of opioid use in individuals with IIM (2004 – 2023).

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/prevalence-of-and-factors-associated-with-chronic-opioid-use-among-individuals-with-inflammatory-myopathies/