Fairley Jessica L, Hansen Dylan, Proudman Susanna, Sahhar Joanne, Ngian Gene-Siew, Apostolopoulos Diane, Walker Jennifer, Host Lauren V, Stevens Wendy, Ferdowsi Nava, Tabesh Maryam, Nikpour Mandana, Ross Laura
Department of Medicine at St Vincent's Hospital Melbourne, University of Melbourne, Melbourne, VIC, Australia.
Department of Rheumatology, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia.
Rheumatol Adv Pract. 2024 Nov 15;8(4):rkae144. doi: 10.1093/rap/rkae144. eCollection 2024.
To define the frequency and associations of opioid use in SSc.
Australian Scleroderma Cohort Study participants meeting ACR/EULAR criteria for SSc were included. Current or previous opioid use was recorded at each visit, with long-term use defined as use on two or more consecutive visits. Groups were compared using two-sample -test, Wilcoxon rank sum test or chi-squared test. Generalised estimating equations were used to model longitudinal data.
Of 1951 participants with a mean age of 46.7 years (s.d. 14.4), 88% were female and 12% had ever received any opioids since SSc onset. Of these, 46% recorded opioid use across multiple consecutive study visits. Digital ulcers (63% 52%), synovitis (57% 38%), interstitial lung disease (37% 27%), gastrointestinal (GI) symptoms (upper 97% 88%, lower 90% 80%) and immunosuppression (59% 46%) were all more frequent in opioid-exposed groups ( < 0.05). In multivariable modelling, current opioid use at each study visit was associated with digital ulcers [odds ratio (OR) 1.5 (95% CI 1.1, 2.0), = 0.01], synovitis [OR 1.5 (95% CI 1.1, 2.1), = 0.02], lower GI symptoms [OR 1.8 (95% CI 1.3, 2.6), < 0.01] and poorer physical [OR 1.8 (95% CI 1.3, 2.4), < 0.01] and mental [OR 1.8 (95% CI 1.1, 3.0), = 0.02] quality of life (QoL). Current opioid use was associated with worse fatigue [regression coefficient (RC) 3.0 units (95% CI 1.2, 4.8), < 0.01], functional disability [RC 0.2 (95% CI 0.2, 0.3), < 0.01], dyspnoea [RC 2.0 (95% CI 0.8, 3.1), < 0.01], depression [RC 2.5 (95% CI 0.9, 4.0), < 0.01] and anxiety [RC 2.5 (95% CI 0.9, 4.0), < 0.01].
Opioid use in SSc was associated with musculoskeletal, GI and lung involvement. Opioid prescription was associated with poorer QoL and physical function.
确定硬皮病中阿片类药物使用的频率及相关性。
纳入符合美国风湿病学会（ACR）/欧洲抗风湿病联盟（EULAR）硬皮病标准的澳大利亚硬皮病队列研究参与者。每次访视时记录当前或既往阿片类药物使用情况，长期使用定义为连续两次或更多次访视时使用。使用两样本t检验、Wilcoxon秩和检验或卡方检验对组间进行比较。采用广义估计方程对纵向数据进行建模。
1951名平均年龄为46.7岁（标准差14.4）的参与者中，88%为女性，12%自硬皮病发病以来曾使用过任何阿片类药物。其中，46%在连续多次研究访视中记录有阿片类药物使用。在暴露于阿片类药物的组中，指端溃疡（63%对52%）、滑膜炎（57%对38%）、间质性肺疾病（37%对27%）、胃肠道（GI）症状（上消化道97%对88%，下消化道90%对80%）和免疫抑制（59%对46%）均更为常见（P<0.05）。在多变量建模中，每次研究访视时当前使用阿片类药物与指端溃疡[比值比（OR）1.5（95%置信区间1.1，2.0），P=0.01]、滑膜炎[OR 1.5（95%置信区间1.1，2.1），P=0.02]、下消化道症状[OR 1.8（95%置信区间1.3，2.6），P<0.01]以及较差的身体[OR 1.8（95%置信区间1.3，2.4），P<0.01]和精神[OR 1.8（95%置信区间1.1，3.0），P=0.02]生活质量（QoL）相关。当前使用阿片类药物与更严重的疲劳[回归系数（RC）3.0单位（95%置信区间1.2，4.8），P<0.01]、功能残疾[RC 0.2（95%置信区间0.2，0.3），P<0.01]、呼吸困难[RC 2.0（95%置信区间0.8，3.1），P<0.01]、抑郁[RC 2.5（95%置信区间0.9，4.0），P<0.01]和焦虑[RC 2.5（95%置信区间0.9，4.0），P<0.01]相关。
硬皮病中阿片类药物使用与肌肉骨骼、胃肠道和肺部受累相关。阿片类药物处方与较差的生活质量和身体功能相关。
