Opioid Analgesic Use in Patients with Ankylosing Spondylitis: An Analysis of the Prospective Study of Outcomes in an Ankylosing Spondylitis Cohort

Dau, Jonathan; Lee, Minjae; Ward, Michael M.; Gensler, Lianne S.; Brown, Matthew A.; Learch, Thomas J.; Diekman, Laura; Tahanan, Amirali; Rahbar, Mohammad Hossein; Weisman, Michael H.; Reveille, John D.

doi:10.3899/jrheum.170630

Cited by 22 publications

(12 citation statements)

References 39 publications

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“…Our findings of an association between substance use disorder and an increased risk of OUD agree with the findings of previous studies [28]. This is consistent with a study that found that patients with ankylosing spondylitis (AS) taking opioids medication were more likely to use psychoactive medication like sedatives [29]. Previous studies have also reported that substance use disorders and mental health conditions contribute to the chronic use of opioid in hospitalized patients [30].…”

Section: Discussionsupporting

confidence: 92%

Trends of Opioid Use Disorder and Associated Factors in Hospitalized Patients With Arthritis

Oladunjoye

Gauvin

et al. 2020

Cureus

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Introduction Opioid use was primarily limited to acute pain, postsurgical care, and end of life care setting but now is the most prescribed medication for chronic pain. Arthritis is a chronic disease associated with chronic pain. Given limited options for pain relief in the patient population, these patients are often prescribed opioids and are at increased risk of opioid use disorder (OUD). Therefore, our study aimed to identify factors associated with OUD in patients with arthritis. Methods We analyzed hospitalized adult patients with arthritis with and without OUD using discharge data from National Inpatient Sample (NIS) over five years from January 1, 2010, to December 31, 2014. We looked at trends of OUD in hospitalized patients with arthritis and compared demographic and clinical characteristics of patients with and without OUD using Student's ttest and chi-square test. Multivariate analysis was also used to adjust for variables. Results A total of 21,396,252 arthritis hospitalizations were identified during the five-year study period among which 227,608 had OUD. The prevalence of OUD in arthritis hospitalization increased over the five-year period by 43%. After adjusting for other variables, mental health (OR 2.50 (2.43-2.58)), and substance use (OR 6.39 (6.14-6.66)) disorders were associated with increased odds of OUD. Conclusion The prevalence of OUD among patients with arthritis increased over the five-year study period. Mental health and substance use disorders were associated with increased odds of OUD. More studies are needed to explore alternative pain management options for arthritis patients particularly in those with mental health and substance use disorders.

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Section: Discussionsupporting

confidence: 92%

Trends of Opioid Use Disorder and Associated Factors in Hospitalized Patients With Arthritis

Oladunjoye

Gauvin

et al. 2020

Cureus

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“…In addition to these broader concerns, prescription opioids fail to target the underlying pathology of AS, resulting in suboptimal treatment. This was corroborated by a recent prospective cohort study, in which opioid use among patients with AS was associated with subjective measures such as depression, Bath Ankylosing Spondylitis Disease Activity Index, and Bath Ankylosing Spondylitis Functional Index, rather than objective markers of inflammation 16 . Thus, any trend toward greater opioid use in AS has ramifications at both individual and societal levels.…”

mentioning

confidence: 54%

Opioid Use in Patients with Ankylosing Spondylitis Is Common in the United States: Outcomes of a Retrospective Cohort Study

Sloan

Sheahan²,

Stark³

et al. 2019

J Rheumatol

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Objective.To assess the prevalence of chronic opioid use in patients with ankylosing spondylitis (AS), and to compare the characteristics of patients with and without chronic opioid use.Methods.This was a retrospective cohort study of patients with AS identified in the Truven Health MarketScan Research database between January 1, 2012, and March 31, 2017. Commercial and Medicaid claims data were examined using both specific (720.0 and M45.x) and broader (720.x and M45.x) International Classification of Diseases (ICD) coding definitions. Patients were aged ≥ 18 years on the date of first qualifying ICD code occurrence (the index date). Demographics and clinical characteristics were assessed in the 12-month period preceding the index date. The 12-month followup period was used to assess prevalence and characteristics of chronic opioid use.Results.Chronic opioid use was common among patients with commercial claims (23.5% of ICD 720.0 patients; 27.3% of ICD 720.x patients), and especially those with Medicaid claims (57.1% and 76.7%, respectively). The proportion of patients with claims for anti–tumor necrosis factor therapies during followup was often low, and for Medicaid patients was lower among those with chronic opioid use (29.6% of ICD 720.0 patients; 2.3% of ICD 720.x patients) than those without (47.1% and 7.1%, respectively). Among chronic opioid users in all cohorts, the cumulative supply of opioids was typically high (≥ 270 days in the followup period); most opioids prescribed were Schedule II.Conclusion.Patients with AS receive opioids with disturbing frequency. The infrequent prescription of recommended therapies to these patients reflects a need to optimize treatment further through education of patients and healthcare professionals alike.

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“…At present, there is no effective treatment for AS. Controlling inflammation and alleviating symptoms are the main treatment policy of AS (Dau et al, 2018). In the later period, combined with drug treatment and proper functional exercise can prevent the occurrence of spinal deformity to the greatest extent (van Weely et al, 2016).…”

Section: Discussionmentioning

confidence: 99%

lncRNA MEG3 Suppresses the Progression of Ankylosis Spondylitis by Regulating the Let-7i/SOST Axis

Zhang

et al. 2020

Front. Mol. Biosci.

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Ankylosis spondylitis (AS) is a disease mainly characterized by sacroiliac joint and spinal attachment point inflammation. Long non-coding RNA (lncRNA) plays a key role in the progression of many diseases. However, few studies have been conducted on the function of lncRNA maternally expressed gene 3 (MEG3) in AS. Quantitative real-time polymerase chain reaction (qRT-PCR) was used to measure the relative levels of MEG3, microRNA let-7i, sclerostin (SOST), and inflammatory cytokines. Dual-luciferase reporter assay, RNA immunoprecipitation (RIP) assay and biotin-labeled RNA pull-down assay were used to confirm the interaction between MEG3 and let-7i or let-7i and SOST. In addition, western blot (WB) analysis was performed to detect the protein levels of osteogenesis markers and SOST. The expression levels of MEG3 and SOST were decreased and let-7i was increased in AS patients. MEG3 could interact with let-7i in AS fibroblasts, and let-7i overexpression reversed the suppressive effect of MEG3 upregulation on the inflammation and bone formation of AS. Additionally, let-7i could target SOST, and SOST silencing reversed the inhibitory effect of let-7i inhibitor or MEG3 overexpression on the inflammation and bone formation of AS. Furthermore, SOST expression was positively regulated by MEG3, while was negatively regulated by let-7i. Our results revealed that lncRNA MEG3 promoted SOST expression to restrain the progression of AS by sponging let-7i, which provided a treatment target for AS.

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Opioid Analgesic Use in Patients with Ankylosing Spondylitis: An Analysis of the Prospective Study of Outcomes in an Ankylosing Spondylitis Cohort

Abstract: Opioid usage was more likely to be associated with subjective measures (depression, BASDAI, BASFI) than objective measures (CRP, ESR), suggesting that pain in AS may derive from sources other than spinal inflammation alone.

Cited by 22 publications

References 39 publications

Trends of Opioid Use Disorder and Associated Factors in Hospitalized Patients With Arthritis

Trends of Opioid Use Disorder and Associated Factors in Hospitalized Patients With Arthritis

Opioid Use in Patients with Ankylosing Spondylitis Is Common in the United States: Outcomes of a Retrospective Cohort Study

lncRNA MEG3 Suppresses the Progression of Ankylosis Spondylitis by Regulating the Let-7i/SOST Axis

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