P197 Analgesic prescribing in patients with inflammatory arthritis in the NHS

Scott, Ian C; Bailey, James; White, Christopher; Mallen, Christian D; Muller, Sara

Abstract

Background
There is little evidence analgesics improve pain in inflammatory arthritis (IA), and substantial evidence they have significant harms. Excepting NSAIDs in ankylosing spondylitis (AS), their long-term use is not recommended in guidelines. Despite this, international data suggest pain management in IA involves the substantial and sustained use of opioids (∼40% of North American patients with rheumatoid arthritis [RA] are chronic opioid users). We evaluated analgesic prescribing practice in NHS-managed patients with IA.

Methods
This study was undertaken in the Consultations in Primary Care Archive (CiPCA), containing primary care consultation/prescription data from 9 general practices (∼200,000 patients) in North Staffordshire (UK) from 2000-2015. Repeated cross-sectional analyses evaluated annual prevalence of analgesic prescriptions in (a) patients with IA (RA; psoriatic arthritis [PsA]; AS), and (b) five age, sex, and practice-matched controls without inflammatory rheumatic conditions. Patients without full calendar-years of data were excluded. The numerator was the number of patients receiving oral analgesic prescriptions in a calendar-year; the denominator was the number of patients contributing data within that calendar-year. Analgesic prescriptions were classified into basic, opioids, gabapentinoids, and NSAIDs. Patients were grouped into users, or non-users of analgesics. Users were sub-classified into chronic (≥3 prescriptions across a calendar year), or intermittent (1-2 prescriptions) users.

Results
In all years, the majority (65.1-77.8%) of patients with IA received analgesics, compared with the minority (38.1-42.0%) of controls (Table). Opioid prescribing in IA fell slightly between 2000-2015, but remained common with 45.0% receiving an opioid, and 32.5% being chronic opioid users in 2015. The proportion of patients with IA prescribed gabapentinoids increased from 0% in 2000, to 9.4% in 2015. In contrast, the proportion prescribed NSAIDs fell from 53.3% in 2000, to 24.9% in 2015. In all years, analgesic use was commoner in patients with RA, compared to PsA and AS, and 2-4 times higher in IA than controls.

Citation

Scott, I. C., Bailey, J., White, C., Mallen, C. D., & Muller, S. (2020). P197 Analgesic prescribing in patients with inflammatory arthritis in the NHS. Rheumatology, 59(Supplement_2), https://doi.org/10.1093/rheumatology/keaa111.192

• Journal Article Type: Conference Paper
• Online Publication Date: Apr 20, 2020
• Publication Date: Apr 1, 2020
• Deposit Date: Jun 20, 2023
• Journal: Rheumatology
• Print ISSN: 1462-0324
• Electronic ISSN: 1462-0332
• Publisher: Oxford University Press
• Peer Reviewed: Peer Reviewed
• Volume: 59
• Issue: Supplement_2
• DOI: https://doi.org/10.1093/rheumatology/keaa111.192
• Keywords: Pharmacology (medical); Rheumatology