Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele.
Department of Rheumatology, Haywood Academic Rheumatology Centre, Haywood Hospital, Midlands Partnership NHS Foundation Trust, High Lane, Burslem, Staffordshire, UK.
Rheumatology (Oxford). 2022 Aug 3;61(8):3201-3211. doi: 10.1093/rheumatology/keab870.
International data suggest inflammatory arthritis (IA) pain management frequently involves opioid prescribing, despite little evidence of efficacy, and potential harms. We evaluated analgesic prescribing in English National Health Service-managed patients with IA.
Repeated cross-sectional analyses in the Consultations in Primary Care Archive (primary care consultation and prescription data in nine general practices from 2000 to 2015) evaluated the annual prevalence of analgesic prescriptions in: (i) IA cases (RA, PsA or axial spondyloarthritis [SpA]), and (ii) up to five age-, sex- and practice-matched controls. Analgesic prescriptions were classified into basic, opioids, gabapentinoids and oral NSAIDs, and sub-classified into chronic and intermittent (≥3 and 1-2 prescriptions per calendar year, respectively).
In 2000, there were 594 cases and 2652 controls, rising to 1080 cases and 4703 controls in 2015. In all years, most (65.3-78.5%) cases received analgesics, compared with fewer (37.5-41.1%) controls. Opioid prescribing in cases fell between 2000 and 2015 but remained common with 45.4% (95% CI: 42.4%, 48.4%) and 32.9% (95% CI: 29.8%, 36.0%) receiving at least 1 and ≥3 opioid prescriptions, respectively, in 2015. Gabapentinoid prescription prevalence in cases increased from 0% in 2000 to 9.5% (95% CI: 7.9%, 11.4%) in 2015, and oral NSAID prescription prevalence fell from 53.7% (95% CI: 49.6%, 57.8%) in 2000 to 25.0% (95% CI: 22.4%, 27.7%) in 2015. Across years, analgesic prescribing was commoner in RA than PsA/axial SpA, and 1.7-2.0 times higher in cases than controls.
Analgesic prescribing in IA is common. This is at variance with existing evidence of analgesic efficacy and risks, and guidelines. Interventions are needed to improve analgesic prescribing in this population.
国际数据表明，炎症性关节炎（IA）的疼痛管理经常涉及阿片类药物的处方，尽管疗效证据很少，且存在潜在危害。我们评估了英国国家医疗服务体系管理下的 IA 患者的镇痛药物处方情况。
在初级保健档案咨询（2000 年至 2015 年期间，9 家普通诊所的初级保健咨询和处方数据）中，通过重复的横断面分析，评估了以下情况下的镇痛药物处方的年度流行率：（i）IA 病例（类风湿关节炎、银屑病关节炎或轴性脊柱关节炎[SpA]），以及（ii）最多 5 名年龄、性别和实践相匹配的对照者。镇痛药物处方分为基础、阿片类药物、加巴喷丁类药物和口服 NSAIDs，并细分为慢性和间歇性（分别为≥3 和 1-2 张处方/年）。
2000 年有 594 例病例和 2652 名对照者，到 2015 年上升至 1080 例病例和 4703 名对照者。在所有年份中，大多数（65.3%-78.5%）病例接受了镇痛药物治疗，而接受镇痛药物治疗的对照者较少（37.5%-41.1%）。2000 年至 2015 年间，阿片类药物的处方量有所下降，但仍很常见，2015 年分别有 45.4%（95%CI：42.4%，48.4%）和 32.9%（95%CI：29.8%，36.0%）的病例至少接受了 1 次和≥3 次阿片类药物处方。2000 年，病例中加巴喷丁类药物的处方比例为 0%，到 2015 年增加到 9.5%（95%CI：7.9%，11.4%），而 2000 年口服 NSAIDs 的处方比例为 53.7%（95%CI：49.6%，57.8%），到 2015 年下降到 25.0%（95%CI：22.4%，27.7%）。多年来，RA 的镇痛药物处方比 PsA/轴向 SpA 更为常见，且病例的处方量是对照者的 1.7-2.0 倍。
IA 的镇痛药物处方很常见。这与现有的镇痛效果和风险证据以及指南相矛盾。需要采取干预措施来改善该人群的镇痛药物处方。
