Frequency and Predictors of Opioid Use in Rheumatoid Arthritis and Seronegative Spondyloarthropathy Patients

Document Type : Original Article


1 Rheumatic Diseases Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

2 Clinical Research Development Unit, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran

3 Department of Pharmacodynamics and Toxicology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran



Background: Pain is one of the most challenging symptoms in patients with rheumatoid arthritis (RA) and spondyloarthropathies 
(SpAs), and pain relief is one of the top priorities for improving health-related quality of life. When medication therapy does not 
significantly reduce pain, chronic opioid consumption becomes more prominent in such patients. This study aimed to evaluate 
the state of opioid use in RA and SpA patients.

Methods: This cross-sectional study was performed on 316 patients with RA and spondyloarthropathies (SpAs) from January to 
March 2014. The convenience sampling method was used to select the participants, and by obtaining verbal consent, everyone 
was given 15 minutes to complete a checklist independently. Demographic and opioid use data were evaluated in terms of opioid 
use and its predictors. In this regard, univariate and multivariate logistic regressions were used to evaluate the predictors of opioid 
consumption in patients. All analyses were conducted using SPSS 21 and the significance level was set at P<0.05.

Findings: About 9.5% of all participants, including 8.8% of RA and 22.6% of SpA cases, were opioid abusers. In the first step of the 
analysis, it was observed that opioid abuse was significantly higher in men, married participants, urban residents, patients with no 
biological therapy, and patients with a negative family history of addiction. The most prevalent ways of drug abuse were smoking 
and ingestion. The results of univariate logistic regression analysis revealed SpA and other factors significantly increase the chance 
of opioid abuse. Furthermore, multivariate logistic regression analysis showed male gender (OR=10.4) and negative family history 
of addiction (OR=3.19) significantly affected addiction in RA and SpA patients with a 95% confidence interval.
Conclusion: Lack of suitable responsiveness to medication therapy to relieve pain, inconsistent pain evaluation, and shame of 
asking direct questions about addiction in RA and SpA patients may lead to opioid consumption in some cases. Seronegative SpA 
may make patients more prone to addiction. However, in this study, male gender and no family history of addiction were related 
to opioid abuse.