Keele Research Repository

OBJECTIVES: International data suggest inflammatory arthritis (IA) pain management frequently involves opioid prescribing, despite little evidence of efficacy, and potential harms. We evaluated analgesia prescribing in English National Health Service-managed patients with IA.

METHODS: Repeated cross-sectional analyses in the Consultations in Primary Care Archive (primary care consultation/prescription data in 9 general practices from 2000-2015) evaluated the annual prevalence of analgesia prescriptions in: (a) IA cases (rheumatoid arthritis [RA]/psoriatic arthritis [PsA]/axial spondyloarthritis [SpA]), and (b) up-to five age/sex/practice-matched controls. Analgesia prescriptions were classified into basic/opioids/gabapentinoids/oral non-steroidal anti-inflammatory drugs (NSAIDs), and sub-classified into chronic and intermittent (≥3 and 1-2 prescriptions/calendar-year, respectively).

RESULTS: In 2000, there were 594 cases/2,652 controls, rising to 1,080 cases/4,703 controls in 2015. In all years, most (65.3-78.5%) cases received analgesia, compared with fewer (37.5-41.1%) controls. Opioid prescribing in cases fell between 2000-2015 but remained common with 45.4% (95% confidence interval [CI] 42.4%, 48.4%) and 32.9% (95% CI 29.8%, 36.0%) receiving at least 1 and ≥3 opioid prescriptions, respectively in 2015. Gabapentinoid prescription prevalence in cases increased from 0% in 2000, to 9.5% (95% CI 7.9%, 11.4%) in 2015, and oral NSAID prescription prevalence fell from 53.7% (95% CI 49.6%, 57.8%) in 2000, to 25.0% (95% CI 22.4%, 27.7%) in 2015. Across years, analgesia prescribing was commoner in RA than PsA/axial SpA, and 1.7-2.0 times higher in cases than controls.

CONCLUSIONS: Analgesia prescribing in IA is common. This is at variance with existing evidence of analgesia efficacy/risks, and guidelines. Interventions are needed to improve analgesia prescribing in this population.