The frequency and clinical associations of opioid use in systemic sclerosis

Abstract

Objective To define the frequency and associations of opioid use in systemic sclerosis (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 ≥ 2 consecutive visits. Groups were compared using two-sample t-test, Wilcoxon rank-sum or chi-squared tests. Generalised estimating equations were used to model longitudinal data. Results Of 1951 participants with mean age 46.7 ± 14.4 years, 88% were female and 12% had ever received any opioids since SSc onset. Of these, 46% recorded opioid across multiple consecutive study visits. Digital ulcers (DU; 63% vs.s 52%), synovitis (57% vs.s 38%), interstitial lung disease (37% vs.s 27%), gastrointestinal symptoms (upper 97% vs.s 88%; lower 90% vs.s 80%) and immunosuppression (59% vs.s 46%) were all more frequent in opioid-exposed groups (p < 0.05). In multivariable modelling, current opioid use at each study visit was associated with DU (OR1.5, 95%CI 1.1–2.0, p = 0.01), synovitis (OR 1.5, 95%CI 1.1–2.1, p = 0.02), lower gastrointestinal symptoms (OR 1.8, 95%CI 1.3–2.6, p < 0.01) and poorer physical (OR1.8, 95%CI1.3–2.4, p < 0.01) and mental (OR1.8, 95%CI1.1–3.0, p = 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, p < 0.01), functional disability (RC 0.2, 95%CI 0.2–0.3, p < 0.01), dyspnoea (RC 2.0, 95%CI 0.8–3.1, p < 0.01), depression (RC 2.5, 95%CI 0.9–4.0 p < 0.01) and anxiety (RC 2.5, 95%CI 0.9–4.0 p < 0.01). Conclusions Opioid use in SSc was associated with musculoskeletal, gastrointestinal and lung involvement. Opioid prescription was associated with poorer QoL and physical function.