The frequency and clinical associations of opioid use in systemic sclerosis.

OBJECTIVE

To define the frequency and associations of opioid use in SSc.

METHODS

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.

RESULTS

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].

CONCLUSIONS

Opioid use in SSc was associated with musculoskeletal, GI and lung involvement. Opioid prescription was associated with poorer QoL and physical function.