乌鸦传媒

A study at the American College of Rheumatology (ACR) annual meeting looked at the association between opioid use and healthcare utilization and costs among patents with psoriatic arthritis (PsA) and ankylosing spondylitis (axSpA).

In this exclusive 乌鸦传媒 video, , associate professor of medicine at the Hospital of the University of Pennsylvania in Philadelphia, discusses .

The following is a transcript of her remarks:

So one of the studies we just presented was on opiate use among patients with psoriatic arthritis and axSpA in the FORWARD databank.

So the FORWARD databank is a patient registry where patients contribute data themselves -- they tell us about their medicines, they tell us about their disease activity. They also tell us about healthcare utilization, how many times they've been to the hospital recently, for example, or [emergency department] visits, x-rays, and so on.

So in the abstract we found that first of all, there was a pretty high opiate use. It was slightly higher in axSpA than PsA, but still around 20% of patients were reporting opiate use, which is much higher than we obviously want. And then we wanted to know how are those patients different from the patients not on opiates.

One assumption might be that those patients are not getting treated well and so they're getting opiates in lieu of therapy. But actually there was more biologic use and also more csDMARD [conventional synthetic disease-modifying antirheumatic drug] use among those patients. And then also significantly higher healthcare utilization and also higher disease activity that was patient reported. So those patients on opiates are kind of overall a more severe phenotype.

And it might be that one, it's a circular argument in some ways that being on opiates gets kind of more advanced scores or for those more advanced patients, but also maybe the pain-seeking behavior and so on.

So those patients are difficult to deal with, but opiates are not really the right way to deal with that. And so we have to think about other items in our toolbox that we can utilize to get them to better disease-activity levels.

So what are those other things in the toolbox? Some of those might be non-opiate pain medications like gabapentin, amitriptyline, duloxetine, for example. Other things might be more physical therapy, getting people exercising, healthier lifestyle habits, decreasing smoking, because smoking is associated with worse outcomes as well. So lots of those other lifestyle and health and wellness aspects of the disease that we could be doing better, that we're really not doing well in clinical practice in general.

So some key takeaways would be, first of all, don't prescribe opiates for psoriatic arthritis or axSpA, it's really not a treatment for those diseases and it may actually enhance pain-seeking behavior and pain and then make them feel worse and decrease quality of life. So opiates are not a treatment for these conditions. And number two, think about the whole patient and the kind of holistic approach to caring for the patient as opposed to just giving a next therapy. Think about what else it is that we can do to help them get to a better place.

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