Session Information
Date: Sunday, November 5, 2017
Title: Rheumatoid Arthritis – Clinical Aspects Poster I: Treatment Patterns and Response
Session Type: ACR Poster Session A
Session Time: 9:00AM-11:00AM
Smoking and Opioid Use Is Associated with Symptom Severity in Rheumatoid Arthritis
Background/Purpose: Cigarette smoking, both current and past, is a risk for incident rheumatoid arthritis (RA), even for those with low exposure rates of 1-10 pack years. As smoking is associated with opioid use in patients with chronic pain, the aim of the current analysis was to examine disease status for RA patients and the relationship between current cigarette smoking and opioid use.
Methods: As part of a study to evaluate cigarette and marijuana smoking in rheumatic disease patients, 1000 consecutively attending rheumatology patients completed an anonymous self-administered questionnaire including: pain severity on visual analog scale (VAS), patient global assessment (PtGA) and cigarette or marijuana smoking status. Concomitant physician recorded information included: diagnosis, sociodemographics, co-morbidities, treatments for RA and physician global assessment (PGA). Patients were categorized according to current smoking status and opioid use. Patient characteristics were compared between groups with one-way ANOVA.
Results: 248 patients were diagnosed with RA [mean (SD) age = 62.4 (14.3) years and 77.4% female] stratified by smoking status and opioid use: 9 patients were current smokers and opioid users, 186 patients non-smokers and non-opioid users, and 53 patients current smokers or opioid users (Table 1). Unemployment/ disability was statistically different between groups (current smokers & opioid users vs. non-smokers & non-opioid users vs. current smokers or opioid users: 11.1% vs. 3.3% vs. 13.5%; p = 0.015). Current smokers and opioid users reported significantly worse disease, including higher PGA (p < 0.001), PtGA (p = 0.021) and pain VAS (p = 0.001), followed by current smokers or opioid users. In regard to medication use, current smokers and opioid users took significantly more medications for disease management (p < 0.001), specifically NSAIDs (p = 0.019) and anti-epileptics (p = 0.020) with a trend towards more antidepressant use (p = 0.088).
Conclusion: Current smoking and opioid use is significantly associated with increased disease severity and other medication use, indicating that RA patients who smoke experience greater symptom severity and may use chemical coping methods to alleviate symptoms.
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Table 1. Patient Profile by Smoking Status and Opioid Use |
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All patients (N=248) |
Current smokers & opioid users (n = 9) |
Non-smokers & non-opioid users (n = 186)
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Current smokers or opioid users (n = 53) |
p-value |
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Demo-graphics |
Age, years, mean (SD) |
62.4 (14.3) |
59.6 (11.8) |
62.9 (15.2) |
61.3 (11.3) |
0.656 |
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Female gender, n (%) |
192 (77.4%) |
7 (77.8%) |
147 (79.0%) |
38 (71.7%) |
0.530 |
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Employment |
0.116
|
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Full-time, n (%)
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83 (33.9%) |
3 (33.3%) |
61 (33.2%) |
19 (36.5%) |
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Part-time, n (%)
|
8 (3.3%) |
0 (0.0%) |
4 (2.2%) |
4 (7.7%) |
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Student, n (%)
|
2 (0.8%) |
0 (0.0%) |
2 (1.1%) |
0 (0.0%) |
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Unemployed, n (%)
|
3 (1.2%) |
0 (0.0%) |
2 (1.1%) |
1 (1.9%) |
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Disabled, n (%)
|
11 (4.5%) |
1 (11.1%) |
4 (2.2%) |
6 (11.5%) |
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Retired, n (%)
|
119 (48.6%) |
4 (44.4%) |
94 (51.1%) |
21 (40.4%) |
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Homemaker, n (%)
|
19 (7.8%) |
1 (11.1%) |
17 (9.2%) |
1 (1.9%) |
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Employment: unemployed/disabled |
0.0151
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Yes, n (%)
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14 (5.7%) |
1 (11.1%) |
6 (3.3%) |
7 (13.5%) |
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No, n (%)
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231 (94.3%) |
8 (88.9%) |
178 (96.7%) |
45 (86.5%) |
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Comorbid conditions |
Cardiovascular, n (%) |
74 (29.8%) |
3 (33.3%) |
57 (30.6%) |
14 (26.4%) |
0.816 |
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Pulmonary, n (%) |
14 (5.6%) |
1 (11.1%) |
10 (5.4%) |
3 (5.7%) |
0.767 |
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Gastrointestinal, n (%) |
25 (10.1%) |
0 (0.0%) |
22 (11.8%) |
3 (5.7%) |
0.249 |
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Neurological, n (%) |
4 (1.6%) |
0 (0.0%) |
3 (1.6%) |
1 (1.9%) |
0.917 |
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Endocrine, n (%) |
50 (20.2%) |
1 (11.1%) |
38 (20.4%) |
11 (20.8%) |
0.787 |
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Mood disorder, n (%) |
26 (10.5%) |
2 (22.2%) |
18 (9.7%) |
6 (11.3%) |
0.475 |
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Other psychiatric disorder, n (%) |
1 (0.4%) |
0 (0.0%) |
1 (0.5%) |
0 (0.0%) |
0.846 |
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Lipid disorder, n (%) |
31 (12.5%) |
2 (22.2%) |
21 (11.3%) |
8 (15.1%) |
0.508 |
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Other comorbid condition, n (%) |
17 (6.9%) |
1 (11.1%) |
14 (7.5%) |
2 (3.8%) |
0.556 |
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Medica-tions for rheumatic diseases |
Number of medication types for rheumatic disease, mean (SD) |
2.0 (1.1) |
3.6 (1.3) |
1.8 (1.0) |
2.3 (1.1) |
< 0.001
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Non-steroidal anti-inflammatory drug use, n (%)
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110 (44.4%) |
7 (77.8%) |
74 (39.8%) |
29 (54.7%) |
0.019
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Disease-modifying anti-rheumatic drug use, n (%)
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184 (74.2%) |
7 (77.8%) |
134 (72.0%) |
43 (81.1%) |
0.398 |
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Biologic use, n (%)
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70 (28.2%) |
2 (22.2%) |
48 (25.8%) |
20 (37.7%) |
0.216 |
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Opioids use, n (%)
|
23 (9.3%) |
9 (100.0%) |
0 (0.0%) |
14 (26.4%) |
< 0.001
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Tranquilizer use, n (%)
|
3 (1.2%) |
0 (0.0%) |
3 (1.6%) |
0 (0.0%) |
0.603 |
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Antiepileptic use, n (%)
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12 (4.8%) |
2 (22.2%) |
6 (3.2%) |
4 (7.5%) |
0.020
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Antidepressant use, n (%)
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14 (5.6%) |
2 (22.2%) |
9 (4.8%) |
3 (5.7%) |
0.088
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Steroid use, n (%)
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73 (29.4%) |
3 (33.3%) |
60 (32.3%) |
10 (18.9%) |
0.163 |
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Disease assessment |
Physician Global Assessment (PGA) (0-10), mean (SD) |
2.7 (2.3) |
4.4 (1.6) |
2.3 (2.2) |
3.8 (2.4) |
< 0.001
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Patient Global Assessment (PtGA) (0-10), mean (SD) |
3.2 (2.7) |
4.5 (2.5) |
2.9 (2.6) |
3.9 (2.8) |
0.021
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Pain, VAS cm, mean (SD) |
4.0 (2.9) |
6.6 (2.0) |
3.7 (2.7) |
4.9 (3.1) |
0.001
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Cigarette use |
Past cigarette use |
n (%) |
145 (58.5%) |
9 (100.0%) |
89 (47.8%) |
47 (88.7%) |
< 0.001
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Years, mean (SD)2
|
26.5 (13.6) |
40.0 (13.2) |
21.9 (11.4) |
32.5 (13.5) |
< 0.001
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Cigarettes/day, mean (SD)2
|
15.3 (8.0) |
21.1 (12.4) |
15.6 (7.7) |
13.6 (7.1) |
0.042
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Current cigarette use |
n (%) |
46 (18.7%) |
9 (100.0%) |
0 (0.0%) |
37 (72.5%) |
< 0.001
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Cigarettes/day, mean (SD)2
|
13.2 (9.7) |
20.1 (12.9) |
NA |
11.5 (8.1) |
0.015
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Herbal cannabis use3 |
Recreational herbal cannabis use |
Ever use, n (%) |
35 (14.2%) |
3 (33.3%) |
22 (11.9%) |
10 (19.2%) |
0.101
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Current use, n (%) |
3 (8.6%) |
0 (0.0%) |
3 (13.6%) |
0 (0.0%) |
0.379 |
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Medical herbal cannabis use |
Ever use, n (%)4 |
4 (1.6%) |
0 (0.0%) |
2 (1.1%) |
2 (3.8%) |
0.363 |
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More than 10 times, n (%)4 |
2 (50.0%) |
NA |
1 (50.0%) |
1 (50.0%) |
> 0.999 |
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Current medical use, n (%)4 |
2 (50.0%) |
NA |
1 (50.0%) |
1 (50.0%) |
> 0.999 |
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If never used, consider medical herbal cannabis use, n (%)5 |
75 (36.2%) |
6 (75.0%) |
52 (33.5%) |
17 (38.6%) |
0.055
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Current herbal cannabis use (any reason)7 |
Current use, n (%) |
4 (11.1%) |
0 (0.0%) |
3 (13.6%) |
1 (9.1%) |
0.755 |
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Daily grams used, mean (SD) |
2.0 (2.8) |
NA |
2.0 (2.8) |
NA |
0.667 |
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Monthly grams used, mean (SD) |
38.0 (64.1) |
NA |
38.0 (64.1) |
NA6 |
0.667 |
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Method of herbal cannabis use |
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Smoke, n (%)
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4 (100.0%) |
NA |
3 (100.0%) |
1 (100.0%) |
NC |
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Vaporize, n (%)
|
1 (25.0%) |
NA |
1 (33.3%) |
0 (0.0%) |
> 0.999 |
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Eat, n (%)
|
1 (25.0%) |
NA |
1 (33.3%) |
0 (0.0%) |
> 0.999 |
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Rub, n (%)
|
0 (0.0%) |
NA |
0 (0.0%) |
0 (0.0%) |
NC |
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Current medical herbal cannabis use |
Relief of symptoms, mean (0-10) (SD)8 |
6.6 (1.6) |
NA |
7.7 (NC) |
5.5 (NC) |
NC |
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NA, not applicable; NC, non calculable. Significant (p<0.05) p-values indicated in bold. Statistical trends (0.05 < p < 0.15) indicated in italics. 1Between unemployed/disabled and full-time/part-time/student/retired/homemaker patients. 2Among smokers. 3Patients may have used more than one method of herbal cannabis. 4Denominator of this proportion represents the total number of patients who have used herbal cannabis for medical reasons (n=2). 5Denominator of this proportion represents the total number of patients who have never used herbal cannabis for medical reasons (n=212). 6Patient reported no daily amount of herbal cannabis, though reported ‘1 gram’ as monthly usage. This was omitted from the description of the results. 7Proportions and p-values are based on the number of patients currently using herbal cannabis for any reason (All patients: n=4; Current smokers and opioid users: n=0; Non-smokers and non-opioid users: n=3; Current smokers or opioid users: n=1). 8Among patients using herbal cannabis for medical reasons. Minimum (0) represents ‘no relief’ and maximum (10) represents ‘maximum relief”. |
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To cite this abstract in AMA style:
Karellis A, Rampakakis E, Sampalis JS, Cohen M, Starr M, Ste-Marie P, Shir Y, Ware M, FitzCharles M. Smoking and Opioid Use Is Associated with Symptom Severity in Rheumatoid Arthritis [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/smoking-and-opioid-use-is-associated-with-symptom-severity-in-rheumatoid-arthritis/. Accessed .« Back to 2017 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/smoking-and-opioid-use-is-associated-with-symptom-severity-in-rheumatoid-arthritis/