Use of Pain Medications in Rheumatology Dips After Patients Start Biologics

A new report finds roughly three-quarters of patients with ankylosing spondylitis, psoriatic arthritis, and rheumatoid arthritis used painkillers, although biologics appear to curb the need for nonsteroidal anti-inflammatory drugs, in particular.

Patients with 3 common rheumatological conditions use pain medications at a high rate, though a new study shows usage tends to drop notably in the first year after initiation of biologics.

The study was published in the journal Rheumatology and Therapy and focused on patients with ankylosing spondylitis (AS), psoriatic arthritis (PsA), and rheumatoid arthritis (RA). Chronic pain, stiffness, and swelling are common in all 3 conditions, and physicians often prescribe nonsteroidal anti-inflammatory drugs (NSAIDs), glucocorticoids, and opioids to help patients manage pain. Corresponding author Theresa Hunter, PhD, MPH, MS, of Eli Lilly, and colleagues, wanted to better understand pain medication usage among these patient populations, particularly once patients had initiated therapy using biologics to treat the underlying disease.

To track pain medication usage, the investigators analyzed a large administrative claims database, looking for patients newly diagnosed with 1 of the 3 diseases. The patients in the study were all adults and all were diagnosed between the years 2014 and 2017.

A total of 2180 patients with AS, 5681 patients with PsA, and 34,047 patients with RA were included in the analysis of overall pain medication. A smaller subset of patients (188 with AS, 921 with PsA, and 1599 with RA) were analyzed to see how biologic use affected pain medication patterns. For both analyses, groups were matched based on demographic and baseline clinical characteristics.

Investigators found high overall rates of pain medication use in all 3 disease categories; 74.6% of patients with RA, 75.0% of patients with PsA, and 83.0% of patients with RA reported using any pain medication during the study’s baseline period. In all 3 cases, pain medication use was higher for patients with one of the diseases than for a group of matched controls. The most common drugs were NSAIDs for patients with AS and glucocorticoids for patients with PsA and RA.

Two years after diagnosis, patients were still using pain medications at high rates: 73.5%, 74.1%, and 81.3% for patients with AS, PsA, and RA, respectively.

Once patients were prescribed a biologic, the subgroup analysis found their pain medication usage generally decreased, particularly in terms of NSAID use.

In patients with AS, NSAID use fell from 68.1% to 51.1% in the year following biologic initiation, compared to the year before biologic treatment. Over the same time period, glucocorticoid use fell from 56.4% to 41.5%.

In patients with PsA, NSAID use dropped from 51.1% to 42.5%, glucocorticoid use fell from 57.4% to 46.9%, and opioid use fell from 38.1% to 33.8%.

Patients with RA had the most comprehensive drop in pain medication, with decreases in 4 different categories of pain medications.

Patients with RA used NSAIDs at a rate of 61.1% before their biologic prescription and at a rate of 41.5% after, while use of glucocorticoids fell from 88.2% to 75.3%, opioid use fell from 52.0% to 40.4%, and neuromodulator use dropped from 47.4% to 44.5%.

The authors wrote that the data help clarify the ways in which disease burden, quality of life, and pain medication use change, and do not change, once a diagnosis is made and after biologic therapy. Those issues are especially important, they noted, in light of the high costs of some pain medications and the risk of addiction among opioid users.

“The usage patterns of pain medications in patients with AS, PsA, and RA suggest that there is need for an effective pain management plan after proper evaluation to establish a diagnosis, with measurable outcomes that focus on improvements, including quality of life, improved functionality, and activities of daily living,” they wrote, adding that nonpharmacological approaches, such as acupuncture and yoga, warrant additional study.

Reference

Hunter T, Nguyen C, Birt J, et al. Pain medication and corticosteroid use in ankylosing spondylitis, psoriatic arthritis, and rheumatoid arthritis in the United States: A retrospective observational study. Rheumatol Ther. Published online July 26, 2021. doi:10.1007/s40744-021-00344-6