Obesity and the Risk of Incident Chronic Opioid Use in Rheumatoid Arthritis

Abstract

Objective The present study was undertaken to evaluate whether the rate of incident chronic opioid use is higher in obese patients with rheumatoid arthritis (RA). Methods Participants with RA in the FORWARD databank were asked about their use of weak and strong opioid medications on semiannual surveys. Incident chronic opioid use was defined as new reported use extending over 2 contiguous surveys (~7–12 months). Cox proportional hazards models were used to evaluate associations between body mass index (BMI) at enrollment and incident chronic opioid use (overall use and strong opioid use). Models adjusted for demographics, smoking, disease duration, RA treatments, household income, and education level. The predicted 5‐year cumulative incidence was calculated from Cox models. Results Among 19,794 participants, 2,802 experienced an incident episode of chronic opioid use over 93,254 person‐years of follow‐up. Higher BMI was associated with higher risk of chronic opioid use. Severe obesity (BMI >35 kg/m2) was associated with a higher risk of overall use (adjusted hazard ratio [HRadj] 1.74 [95% confidence interval (95% CI) 1.72–2.04], P < 0.0001) and strong opioid use (HRadj 2.11 [95% CI 1.64–2.71], P < 0.001) compared to normal BMI. This association was partially explained by greater comorbidity, pain, and disability in obese groups. The attributable risk for obesity was 15% of overall opioid use and 24% of strong opioid use. Conclusion Obesity is associated with a substantially higher risk of incident chronic opioid use. Approximately 1 in 4 cases of incident use of strong opioids may be attributable to obesity, suggesting a major public health impact. Interventions to prevent or reduce obesity could have an important impact on the use of opioids.

Risk of Prostate Cancer in US Veterans With Rheumatoid Arthritis

“…We assessed covariates that are potential risk factors for prostate cancer. These covariates included race (self‐identified at enrollment), smoking status (current, former, never), Agent Orange exposure (based on VA enrollment records), health care resource utilization (number of outpatient visits in the year prior to index date and number of primary care provider visits within the year prior to index date), body mass index (using the most recent weight prior to index date and the modal height) (16–18), Rheumatic Disease Comorbidity Index score (19), and prior screening for prostate cancer (presence of a prostate‐specific antigen [PSA] test in the year prior to the index date). Agent Orange was included based on prior evidence suggesting a potential association with prostate cancer risk (20,21).…”

Review of publications evaluating opioid use in patients with inflammatory rheumatic disease

“…Chronic opioids are prescribed to 17% to 67% of US patients with RA. The highest recent estimate is from a study of Social Security Disability Insurance beneficiaries less than 65 years of age (Table 1) [6 ▪ –8 ▪ ,9 ▪▪ ,10–14]. A cross-sectional study of the National Ambulatory Medical Care Survey examining data from 2011 to 2016 showed that one-fourth of US office visits for RA involved an opioid prescription; opioid prescribing for outpatient RA visits increased from 15% to 34% ( P < 0.0001) over the time frame; and primary care physicians were the most common prescribers [6 ▪ ].…”

“…Chronic opioid use in RA has been associated with fibromyalgia [6 ▪ ,11], anxiety [11], antidepressant use [11,14], and smoking [8 ▪ ]. However, antidepressants are sometimes used as a treatment modality for pain [23–24] which complicates the interpretation of antidepressant use in these studies.…”

“…Disability has also been associated with long-term opioid use in multiple studies [7 ▪ ,8 ▪ ,14]. Baker and colleagues [8 ▪ ] reported results from the FORWARD databank between 1999 and 2019 showing that obese RA patients had greater comorbidities, pain, and disability.…”

“…Disability has also been associated with long-term opioid use in multiple studies [7 ▪ ,8 ▪ ,14]. Baker and colleagues [8 ▪ ] reported results from the FORWARD databank between 1999 and 2019 showing that obese RA patients had greater comorbidities, pain, and disability. Higher BMI in this study was associated with higher risk of chronic opioid use, and severe obesity was associated with a higher risk of strong opioid use [aHR 2.1, 95% CI 1.6–2.7].…”