Huang Yun-Ting, Jenkins David A, Yimer Belay Birlie, Jani Meghna
Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, The University of Manchester, Manchester, UK.
Centre for Health Informatics, Division of Informatics, Imaging and Data Science, The University of Manchester, Manchester, UK.
Rheumatology (Oxford). 2025 Apr 1;64(4):1844-1852. doi: 10.1093/rheumatology/keae444.
Up to one in five patients with axial spondyloarthritis (AxSpA) or psoriatic arthritis (PsA) newly initiated on opioids transition to long-term use within the first year. This study aimed to investigate individual factors associated with long-term opioid use among opioid new users with AxSpA/PsA.
Adult patients with AxSpA/PsA and without prior cancer who initiated opioids between 2006 and 2021 were included from Clinical Practice Research Datalink Gold, a national UK primary care database. Long-term opioid use was defined as having ≥3 opioid prescriptions issued within 90 days, or ≥90 days of opioid supply, in the first year of follow-up. Individual factors assessed included sociodemographic, lifestyle factors, medication use and comorbidities. A mixed-effects logistic regression model with patient-level random intercept was used to examine the association of individual characteristics with the odds of long-term opioid use.
In total, 10 300 opioid initiations were identified from 8212 patients (3037 AxSpA; 5175 PsA). The following factors were associated with long-term opioid use: being a current smoker (OR: 1.62; 95%CI: 1.38,1.90), substance use disorder (OR: 2.34, 95%CI: 1.05,5.21), history of suicide/self-harm (OR: 1.84; 95%CI: 1.13,2.99), co-existing fibromyalgia (OR: 1.62; 95%CI: 1.11,2.37), higher Charlson Comorbidity Index (OR: 3.61; 95%CI: 1.69,7.71 for high scores), high MME/day at initiation (OR: 1.03; 95%CI: 1.02,1.03) and gabapentinoid (OR: 2.35; 95%CI: 1.75,3.16) and antidepressant use (OR: 1.69; 95%CI: 1.45,1.98).
In AxSpA/PsA patients requiring pain relief, awareness of lifestyle, sociodemographic and prescribing characteristics associated with higher risk of long-term opioid use can prompt timely interventions such as structured medication reviews and smoking cessation to promote safer prescribing and better patient outcomes.
在新开始使用阿片类药物的轴性脊柱关节炎（AxSpA）或银屑病关节炎（PsA）患者中，高达五分之一的患者在第一年就过渡到长期使用。本研究旨在调查AxSpA/PsA阿片类药物新使用者中与长期使用阿片类药物相关的个体因素。
从英国国家初级保健数据库临床实践研究数据链黄金版中纳入2006年至2021年间开始使用阿片类药物、无既往癌症史的AxSpA/PsA成年患者。长期使用阿片类药物的定义为在随访的第一年中，90天内开具≥3张阿片类药物处方，或阿片类药物供应≥90天。评估的个体因素包括社会人口统计学、生活方式因素、药物使用和合并症。使用具有患者水平随机截距的混合效应逻辑回归模型来检验个体特征与长期使用阿片类药物几率之间的关联。
共从8212名患者（3037例AxSpA；例5175 PsA）中确定了10300次阿片类药物起始使用。以下因素与长期使用阿片类药物相关：当前吸烟者（比值比：1.62；95%置信区间：1.38，1.90）、物质使用障碍（比值比：2.34，95%置信区间：1.05，5.21）、自杀/自残史（比值比：1.84；95%置信区间：1.13，2.99）、并存纤维肌痛（比值比：1.62；95%置信区间：1.11，2.37）、较高的查尔森合并症指数（高分数时比值比：3.61；95%置信区间：1.69，7.71）、起始时每日吗啡毫克当量较高（比值比：1.03；95%置信区间：1.02，1.03）以及使用加巴喷丁类药物（比值比：2.35；95%置信区间：1.75，3.16）和抗抑郁药（比值比：1.69；95%置信区间：1.45，1.98）。
在需要缓解疼痛的AxSpA/PsA患者中，了解与长期使用阿片类药物较高风险相关的生活方式、社会人口统计学和处方特征，可促使及时进行干预，如结构化药物审查和戒烟，以促进更安全的处方开具和更好的患者结局。
