Background: Rheumatic pain should no longer be regarded as an isolated symptom as it has detrimental effects on the quality of life of patients. A multimodal approach, integrating non-pharmacologic as well as pharmacologic treatments is recommended in rheumatic diseases (RD). While opioids are frequently prescribed, their efficacy and safety remain debated.

Objectives: This study aimed to describe opioid use in patients with RD and identify factors associated with prolonged use.

Methods: This was a descriptive cross-sectional study including patients with chronic RD: rheumatoid arthritis (RA) according to the ACR/EULAR 2010 classification criteria, spondyloarthritis (SpA) according to the ASAS 2009 criteria, and undifferentiated inflammatory rheumatism. Prolonged opioid use was defined as a prescription or use of opioids for ≥ 90 days. Data were collected using a pre-established form gathering sociodemographic characteristics, RD-related parameters, and treatments received.

Results: The study included 40 patients: RA (n=20), SpA (n=18), and undifferentiated RD (n=2). The male-to-female ratio was 0.48, and the mean age was 51 ± 15 years [19–76]. The average disease duration was 11 ± 10.5 years [0.5–37]. Eight percent of patients were in remission, and 47% had active disease at with a mean DAS28-CRP score of 3.9 ± 1.5 [1.70–6.9] and a mean BASDAI score of 3.3 ± 1.7 [0.8–6]. Eighty-eight percent of patients received symptomatic treatment with NSAIDs (43%), corticosteroids (46%), or a combination of NSAIDs and corticosteroids (11%) for a median duration of 12 months. Currently, 77% of patients were on disease-modifying therapy (csDMARDs: 48%, bDMARDs: 52%, with 90% reporting good adherence). Opioid treatment was prescribed by a rheumatologist in most cases (85%) with an average frequency of 1.38 times per year during the last year of follow-up. Among the studied patients, 73% used one opioid, 15% used two types of opioids, and 13% used three types. Tramadol-paracetamol (35%) was the most prescribed first-line opioid, followed by tramadol alone (33%) and codeine-paracetamol (33%). As second-line therapy, the most prescribed opioid was again tramadol-paracetamol (80%), followed by tramadol alone (10%) and the combination of codeine-paracetamol (10%). Finally, as third-line therapy, codeine-paracetamol combination was the most prescribed (60%), followed by tramadol-paracetamol (20%) and morphine (20%). The median prescribed duration was 20 days [6–180]. Thirty percent of patients extended their treatment on their own initiative, reaching an average total duration of 65 days ± 34.8. Sixty-three percent of patients were satisfied, with a mean pain VAS score change of 2.9 ± 1.9 [0-8]. Prolonged use was noted in 23% of the patients. Fifty-five percent of patients reported adverse effects, including epigastric pain and vomiting (41%), hallucinations (9%), dependence (9%), dizziness (9%), tolerance (9%), cytolysis (9%), dry mouth (5%), fatigue (5%), and myalgias (5%). Forty-three percent of patients stopped the opioid pain treatment after initiating disease-modifying therapy, while 57% reduced the dosage. Twenty-two percent of patients stopped the opioid pain treatment after modifying their disease-modifying therapy. Prolonged use of opioids was associated with a history of diabetes (p = 0.049), intermittent use of symptomatic treatments (p = 0.028), biologic therapy (p = 0.048), the type of opioid prescribed in first-line therapy (tramadol-paracetamol) (p = 0.046), frequency of prescription over the last year (p = 0.037), and prescribed duration (p = 0.00). No association was found with gender (p = 0.305), age (p = 0.559), type of CIR (p = 0.175), disease duration (p = 0.832), disease activity (p = 0.441), or initial pain VAS score (p = 0.83).

Conclusion: Our study showed the high level of misusage of opioids among patients with RD. Factors associated with high use are the frequency of prescription over the last year, duration of prescription and diabetes. Early identification of misuse risk factors and prioritizing alternatives are crucial.

REFERENCES: NIL.

Acknowledgements: NIL.

Disclosure of Interests: None declared.

© The Authors 2025. This abstract is an open access article published in Annals of Rheumatic Diseases under the CC BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ). Neither EULAR nor the publisher make any representation as to the accuracy of the content. The authors are solely responsible for the content in their abstract including accuracy of the facts, statements, results, conclusion, citing resources etc.