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Opioid use in rheumatoid arthritis

trends, efficacy, safety, and best practices

Day, Alvin Lee; Curtis, Jeffrey R.

Current Opinion in Rheumatology: May 2019 - Volume 31 - Issue 3 - p 264–270
doi: 10.1097/BOR.0000000000000602

Purpose of review The opioid epidemic remains prominent in both the medical literature and popular media. Rheumatologists are among the physicians at the forefront of the epidemic because of the prominent role of pain in rheumatoid arthritis (RA) and the limited options for treatment of pain. The purpose of this review is to provide an update on the trends of opioid use among patients with RA, to discuss the various mechanisms of RA pain, review the available evidence for opioid efficacy in RA, and to promote a guideline for best practices in opioid prescribing.

Recent findings Recent cohort studies have estimated that up to 40% of patients with RA are regular users of opioids, and the effects of disease-modifying antirheumatic drugs are minimal in reducing opioid use. Although the literature supports the efficacy of short-term opioids for the improvement in pain, long-term use is associated with reduced efficacy and increased safety concerns.

Summary Although the data supporting the use of long-term opioid use in patients with RA is poor, rheumatologists can adhere to best practices for determining when and if initiation of opioids is appropriate. Identification of the nature of the pain can help determine the appropriate course of treatment.

Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama, USA

Correspondence to Jeffrey R. Curtis, MD, MS, MPH, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, 1720 2nd Avenue South, FOT 802, Birmingham, AL 35294, USA. Tel: +1 205 934 2176; e-mail:

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