Research ArticleArticle
Opioid Analgesic Use in Patients with Ankylosing Spondylitis: An Analysis of the Prospective Study of Outcomes in an Ankylosing Spondylitis Cohort
Jonathan D. Dau, MinJae Lee, Michael M. Ward, Lianne S. Gensler, Matthew A. Brown, Thomas J. Learch, Laura A. Diekman, Amirali Tahanan, Mohammad H. Rahbar, Michael H. Weisman and John D. Reveille
The Journal of Rheumatology December 2017, jrheum.170630; DOI: https://doi.org/10.3899/jrheum.170630
Jonathan D. Dau
From the Department of Internal Medicine, Division of Rheumatology, and the Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston, Houston, Texas; National Institute of Arthritis and Musculoskeletal and Skin Diseases, US National Institutes of Health, Bethesda, Maryland; Department of Medicine, Division of Rheumatology, University of California San Francisco (UCSF), San Francisco, California, USA; University of Queensland Diamantina Institute, Translational Research Institute, and Institute of Health and Biomedical Innovation, Queensland University of Technology, Princess Alexandra Hospital, Queensland, Australia; Division of Rheumatology, Cedars Sinai Medical Center, Los Angeles, California, USA. Supported by grants from the US Department of Health and Human Services, National Institutes of Health (NIH), National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), P01-052915-06 and from the Spondylitis Association of America. We acknowledge the support provided by the Biostatistics/Epidemiology/Research Design component of the Center for Clinical and Translational Sciences (CCTS) for this project. CCTS is mainly funded by the NIH Centers for Translational Science Award (UL1TR000371) by the National Center for Advancing Translational Sciences (NCATS). Management of data for our study was done using REDCap, which was partly supported by a grant UL1 TR000445 from NCATS/NIH, awarded to Vanderbilt University. Dr. M. Ward is supported by the Intramural Research Program, NIAMS, NIH. Dr. L. Gensler is supported by the Russell/Engleman Rheumatology Research Center at UCSF. J.D. Dau, MD, Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center Houston; M.J. Lee, PhD, Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston; M.M. Ward, MD, MPH, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health; L.S. Gensler, MD, Department of Medicine, Division of Rheumatology, UCSF; M.A. Brown, FRACP, University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital, and Institute of Health and Biomedical Innovation, Queensland University of Technology, Translational Research Institute, Princess Alexandra Hospital; T.J. Learch, MD, Division of Rheumatology, Cedars Sinai Medical Center; L.A. Diekman, MS, Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center Houston; A. Tahanan, BS, Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston; M.H. Rahbar, PhD, Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston; M.H. Weisman, MD, Division of Rheumatology, Cedars Sinai Medical Center; J.D. Reveille, MD, Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center Houston. Address correspondence to Dr. J.D. Reveille, McGovern Medical School at the University of Texas Health Science Center Houston, 6431 Fannin, Houston, Texas 77030, USA. E-mail: John.D.Reveille@uth.tmc.edu. Accepted for publication September 8, 2017.
MinJae Lee
From the Department of Internal Medicine, Division of Rheumatology, and the Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston, Houston, Texas; National Institute of Arthritis and Musculoskeletal and Skin Diseases, US National Institutes of Health, Bethesda, Maryland; Department of Medicine, Division of Rheumatology, University of California San Francisco (UCSF), San Francisco, California, USA; University of Queensland Diamantina Institute, Translational Research Institute, and Institute of Health and Biomedical Innovation, Queensland University of Technology, Princess Alexandra Hospital, Queensland, Australia; Division of Rheumatology, Cedars Sinai Medical Center, Los Angeles, California, USA. Supported by grants from the US Department of Health and Human Services, National Institutes of Health (NIH), National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), P01-052915-06 and from the Spondylitis Association of America. We acknowledge the support provided by the Biostatistics/Epidemiology/Research Design component of the Center for Clinical and Translational Sciences (CCTS) for this project. CCTS is mainly funded by the NIH Centers for Translational Science Award (UL1TR000371) by the National Center for Advancing Translational Sciences (NCATS). Management of data for our study was done using REDCap, which was partly supported by a grant UL1 TR000445 from NCATS/NIH, awarded to Vanderbilt University. Dr. M. Ward is supported by the Intramural Research Program, NIAMS, NIH. Dr. L. Gensler is supported by the Russell/Engleman Rheumatology Research Center at UCSF. J.D. Dau, MD, Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center Houston; M.J. Lee, PhD, Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston; M.M. Ward, MD, MPH, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health; L.S. Gensler, MD, Department of Medicine, Division of Rheumatology, UCSF; M.A. Brown, FRACP, University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital, and Institute of Health and Biomedical Innovation, Queensland University of Technology, Translational Research Institute, Princess Alexandra Hospital; T.J. Learch, MD, Division of Rheumatology, Cedars Sinai Medical Center; L.A. Diekman, MS, Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center Houston; A. Tahanan, BS, Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston; M.H. Rahbar, PhD, Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston; M.H. Weisman, MD, Division of Rheumatology, Cedars Sinai Medical Center; J.D. Reveille, MD, Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center Houston. Address correspondence to Dr. J.D. Reveille, McGovern Medical School at the University of Texas Health Science Center Houston, 6431 Fannin, Houston, Texas 77030, USA. E-mail: John.D.Reveille@uth.tmc.edu. Accepted for publication September 8, 2017.
Michael M. Ward
From the Department of Internal Medicine, Division of Rheumatology, and the Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston, Houston, Texas; National Institute of Arthritis and Musculoskeletal and Skin Diseases, US National Institutes of Health, Bethesda, Maryland; Department of Medicine, Division of Rheumatology, University of California San Francisco (UCSF), San Francisco, California, USA; University of Queensland Diamantina Institute, Translational Research Institute, and Institute of Health and Biomedical Innovation, Queensland University of Technology, Princess Alexandra Hospital, Queensland, Australia; Division of Rheumatology, Cedars Sinai Medical Center, Los Angeles, California, USA. Supported by grants from the US Department of Health and Human Services, National Institutes of Health (NIH), National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), P01-052915-06 and from the Spondylitis Association of America. We acknowledge the support provided by the Biostatistics/Epidemiology/Research Design component of the Center for Clinical and Translational Sciences (CCTS) for this project. CCTS is mainly funded by the NIH Centers for Translational Science Award (UL1TR000371) by the National Center for Advancing Translational Sciences (NCATS). Management of data for our study was done using REDCap, which was partly supported by a grant UL1 TR000445 from NCATS/NIH, awarded to Vanderbilt University. Dr. M. Ward is supported by the Intramural Research Program, NIAMS, NIH. Dr. L. Gensler is supported by the Russell/Engleman Rheumatology Research Center at UCSF. J.D. Dau, MD, Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center Houston; M.J. Lee, PhD, Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston; M.M. Ward, MD, MPH, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health; L.S. Gensler, MD, Department of Medicine, Division of Rheumatology, UCSF; M.A. Brown, FRACP, University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital, and Institute of Health and Biomedical Innovation, Queensland University of Technology, Translational Research Institute, Princess Alexandra Hospital; T.J. Learch, MD, Division of Rheumatology, Cedars Sinai Medical Center; L.A. Diekman, MS, Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center Houston; A. Tahanan, BS, Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston; M.H. Rahbar, PhD, Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston; M.H. Weisman, MD, Division of Rheumatology, Cedars Sinai Medical Center; J.D. Reveille, MD, Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center Houston. Address correspondence to Dr. J.D. Reveille, McGovern Medical School at the University of Texas Health Science Center Houston, 6431 Fannin, Houston, Texas 77030, USA. E-mail: John.D.Reveille@uth.tmc.edu. Accepted for publication September 8, 2017.
Lianne S. Gensler
From the Department of Internal Medicine, Division of Rheumatology, and the Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston, Houston, Texas; National Institute of Arthritis and Musculoskeletal and Skin Diseases, US National Institutes of Health, Bethesda, Maryland; Department of Medicine, Division of Rheumatology, University of California San Francisco (UCSF), San Francisco, California, USA; University of Queensland Diamantina Institute, Translational Research Institute, and Institute of Health and Biomedical Innovation, Queensland University of Technology, Princess Alexandra Hospital, Queensland, Australia; Division of Rheumatology, Cedars Sinai Medical Center, Los Angeles, California, USA. Supported by grants from the US Department of Health and Human Services, National Institutes of Health (NIH), National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), P01-052915-06 and from the Spondylitis Association of America. We acknowledge the support provided by the Biostatistics/Epidemiology/Research Design component of the Center for Clinical and Translational Sciences (CCTS) for this project. CCTS is mainly funded by the NIH Centers for Translational Science Award (UL1TR000371) by the National Center for Advancing Translational Sciences (NCATS). Management of data for our study was done using REDCap, which was partly supported by a grant UL1 TR000445 from NCATS/NIH, awarded to Vanderbilt University. Dr. M. Ward is supported by the Intramural Research Program, NIAMS, NIH. Dr. L. Gensler is supported by the Russell/Engleman Rheumatology Research Center at UCSF. J.D. Dau, MD, Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center Houston; M.J. Lee, PhD, Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston; M.M. Ward, MD, MPH, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health; L.S. Gensler, MD, Department of Medicine, Division of Rheumatology, UCSF; M.A. Brown, FRACP, University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital, and Institute of Health and Biomedical Innovation, Queensland University of Technology, Translational Research Institute, Princess Alexandra Hospital; T.J. Learch, MD, Division of Rheumatology, Cedars Sinai Medical Center; L.A. Diekman, MS, Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center Houston; A. Tahanan, BS, Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston; M.H. Rahbar, PhD, Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston; M.H. Weisman, MD, Division of Rheumatology, Cedars Sinai Medical Center; J.D. Reveille, MD, Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center Houston. Address correspondence to Dr. J.D. Reveille, McGovern Medical School at the University of Texas Health Science Center Houston, 6431 Fannin, Houston, Texas 77030, USA. E-mail: John.D.Reveille@uth.tmc.edu. Accepted for publication September 8, 2017.
Matthew A. Brown
From the Department of Internal Medicine, Division of Rheumatology, and the Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston, Houston, Texas; National Institute of Arthritis and Musculoskeletal and Skin Diseases, US National Institutes of Health, Bethesda, Maryland; Department of Medicine, Division of Rheumatology, University of California San Francisco (UCSF), San Francisco, California, USA; University of Queensland Diamantina Institute, Translational Research Institute, and Institute of Health and Biomedical Innovation, Queensland University of Technology, Princess Alexandra Hospital, Queensland, Australia; Division of Rheumatology, Cedars Sinai Medical Center, Los Angeles, California, USA. Supported by grants from the US Department of Health and Human Services, National Institutes of Health (NIH), National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), P01-052915-06 and from the Spondylitis Association of America. We acknowledge the support provided by the Biostatistics/Epidemiology/Research Design component of the Center for Clinical and Translational Sciences (CCTS) for this project. CCTS is mainly funded by the NIH Centers for Translational Science Award (UL1TR000371) by the National Center for Advancing Translational Sciences (NCATS). Management of data for our study was done using REDCap, which was partly supported by a grant UL1 TR000445 from NCATS/NIH, awarded to Vanderbilt University. Dr. M. Ward is supported by the Intramural Research Program, NIAMS, NIH. Dr. L. Gensler is supported by the Russell/Engleman Rheumatology Research Center at UCSF. J.D. Dau, MD, Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center Houston; M.J. Lee, PhD, Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston; M.M. Ward, MD, MPH, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health; L.S. Gensler, MD, Department of Medicine, Division of Rheumatology, UCSF; M.A. Brown, FRACP, University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital, and Institute of Health and Biomedical Innovation, Queensland University of Technology, Translational Research Institute, Princess Alexandra Hospital; T.J. Learch, MD, Division of Rheumatology, Cedars Sinai Medical Center; L.A. Diekman, MS, Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center Houston; A. Tahanan, BS, Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston; M.H. Rahbar, PhD, Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston; M.H. Weisman, MD, Division of Rheumatology, Cedars Sinai Medical Center; J.D. Reveille, MD, Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center Houston. Address correspondence to Dr. J.D. Reveille, McGovern Medical School at the University of Texas Health Science Center Houston, 6431 Fannin, Houston, Texas 77030, USA. E-mail: John.D.Reveille@uth.tmc.edu. Accepted for publication September 8, 2017.
Thomas J. Learch
From the Department of Internal Medicine, Division of Rheumatology, and the Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston, Houston, Texas; National Institute of Arthritis and Musculoskeletal and Skin Diseases, US National Institutes of Health, Bethesda, Maryland; Department of Medicine, Division of Rheumatology, University of California San Francisco (UCSF), San Francisco, California, USA; University of Queensland Diamantina Institute, Translational Research Institute, and Institute of Health and Biomedical Innovation, Queensland University of Technology, Princess Alexandra Hospital, Queensland, Australia; Division of Rheumatology, Cedars Sinai Medical Center, Los Angeles, California, USA. Supported by grants from the US Department of Health and Human Services, National Institutes of Health (NIH), National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), P01-052915-06 and from the Spondylitis Association of America. We acknowledge the support provided by the Biostatistics/Epidemiology/Research Design component of the Center for Clinical and Translational Sciences (CCTS) for this project. CCTS is mainly funded by the NIH Centers for Translational Science Award (UL1TR000371) by the National Center for Advancing Translational Sciences (NCATS). Management of data for our study was done using REDCap, which was partly supported by a grant UL1 TR000445 from NCATS/NIH, awarded to Vanderbilt University. Dr. M. Ward is supported by the Intramural Research Program, NIAMS, NIH. Dr. L. Gensler is supported by the Russell/Engleman Rheumatology Research Center at UCSF. J.D. Dau, MD, Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center Houston; M.J. Lee, PhD, Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston; M.M. Ward, MD, MPH, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health; L.S. Gensler, MD, Department of Medicine, Division of Rheumatology, UCSF; M.A. Brown, FRACP, University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital, and Institute of Health and Biomedical Innovation, Queensland University of Technology, Translational Research Institute, Princess Alexandra Hospital; T.J. Learch, MD, Division of Rheumatology, Cedars Sinai Medical Center; L.A. Diekman, MS, Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center Houston; A. Tahanan, BS, Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston; M.H. Rahbar, PhD, Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston; M.H. Weisman, MD, Division of Rheumatology, Cedars Sinai Medical Center; J.D. Reveille, MD, Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center Houston. Address correspondence to Dr. J.D. Reveille, McGovern Medical School at the University of Texas Health Science Center Houston, 6431 Fannin, Houston, Texas 77030, USA. E-mail: John.D.Reveille@uth.tmc.edu. Accepted for publication September 8, 2017.
Laura A. Diekman
From the Department of Internal Medicine, Division of Rheumatology, and the Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston, Houston, Texas; National Institute of Arthritis and Musculoskeletal and Skin Diseases, US National Institutes of Health, Bethesda, Maryland; Department of Medicine, Division of Rheumatology, University of California San Francisco (UCSF), San Francisco, California, USA; University of Queensland Diamantina Institute, Translational Research Institute, and Institute of Health and Biomedical Innovation, Queensland University of Technology, Princess Alexandra Hospital, Queensland, Australia; Division of Rheumatology, Cedars Sinai Medical Center, Los Angeles, California, USA. Supported by grants from the US Department of Health and Human Services, National Institutes of Health (NIH), National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), P01-052915-06 and from the Spondylitis Association of America. We acknowledge the support provided by the Biostatistics/Epidemiology/Research Design component of the Center for Clinical and Translational Sciences (CCTS) for this project. CCTS is mainly funded by the NIH Centers for Translational Science Award (UL1TR000371) by the National Center for Advancing Translational Sciences (NCATS). Management of data for our study was done using REDCap, which was partly supported by a grant UL1 TR000445 from NCATS/NIH, awarded to Vanderbilt University. Dr. M. Ward is supported by the Intramural Research Program, NIAMS, NIH. Dr. L. Gensler is supported by the Russell/Engleman Rheumatology Research Center at UCSF. J.D. Dau, MD, Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center Houston; M.J. Lee, PhD, Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston; M.M. Ward, MD, MPH, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health; L.S. Gensler, MD, Department of Medicine, Division of Rheumatology, UCSF; M.A. Brown, FRACP, University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital, and Institute of Health and Biomedical Innovation, Queensland University of Technology, Translational Research Institute, Princess Alexandra Hospital; T.J. Learch, MD, Division of Rheumatology, Cedars Sinai Medical Center; L.A. Diekman, MS, Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center Houston; A. Tahanan, BS, Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston; M.H. Rahbar, PhD, Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston; M.H. Weisman, MD, Division of Rheumatology, Cedars Sinai Medical Center; J.D. Reveille, MD, Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center Houston. Address correspondence to Dr. J.D. Reveille, McGovern Medical School at the University of Texas Health Science Center Houston, 6431 Fannin, Houston, Texas 77030, USA. E-mail: John.D.Reveille@uth.tmc.edu. Accepted for publication September 8, 2017.
Amirali Tahanan
From the Department of Internal Medicine, Division of Rheumatology, and the Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston, Houston, Texas; National Institute of Arthritis and Musculoskeletal and Skin Diseases, US National Institutes of Health, Bethesda, Maryland; Department of Medicine, Division of Rheumatology, University of California San Francisco (UCSF), San Francisco, California, USA; University of Queensland Diamantina Institute, Translational Research Institute, and Institute of Health and Biomedical Innovation, Queensland University of Technology, Princess Alexandra Hospital, Queensland, Australia; Division of Rheumatology, Cedars Sinai Medical Center, Los Angeles, California, USA. Supported by grants from the US Department of Health and Human Services, National Institutes of Health (NIH), National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), P01-052915-06 and from the Spondylitis Association of America. We acknowledge the support provided by the Biostatistics/Epidemiology/Research Design component of the Center for Clinical and Translational Sciences (CCTS) for this project. CCTS is mainly funded by the NIH Centers for Translational Science Award (UL1TR000371) by the National Center for Advancing Translational Sciences (NCATS). Management of data for our study was done using REDCap, which was partly supported by a grant UL1 TR000445 from NCATS/NIH, awarded to Vanderbilt University. Dr. M. Ward is supported by the Intramural Research Program, NIAMS, NIH. Dr. L. Gensler is supported by the Russell/Engleman Rheumatology Research Center at UCSF. J.D. Dau, MD, Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center Houston; M.J. Lee, PhD, Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston; M.M. Ward, MD, MPH, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health; L.S. Gensler, MD, Department of Medicine, Division of Rheumatology, UCSF; M.A. Brown, FRACP, University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital, and Institute of Health and Biomedical Innovation, Queensland University of Technology, Translational Research Institute, Princess Alexandra Hospital; T.J. Learch, MD, Division of Rheumatology, Cedars Sinai Medical Center; L.A. Diekman, MS, Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center Houston; A. Tahanan, BS, Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston; M.H. Rahbar, PhD, Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston; M.H. Weisman, MD, Division of Rheumatology, Cedars Sinai Medical Center; J.D. Reveille, MD, Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center Houston. Address correspondence to Dr. J.D. Reveille, McGovern Medical School at the University of Texas Health Science Center Houston, 6431 Fannin, Houston, Texas 77030, USA. E-mail: John.D.Reveille@uth.tmc.edu. Accepted for publication September 8, 2017.
Mohammad H. Rahbar
From the Department of Internal Medicine, Division of Rheumatology, and the Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston, Houston, Texas; National Institute of Arthritis and Musculoskeletal and Skin Diseases, US National Institutes of Health, Bethesda, Maryland; Department of Medicine, Division of Rheumatology, University of California San Francisco (UCSF), San Francisco, California, USA; University of Queensland Diamantina Institute, Translational Research Institute, and Institute of Health and Biomedical Innovation, Queensland University of Technology, Princess Alexandra Hospital, Queensland, Australia; Division of Rheumatology, Cedars Sinai Medical Center, Los Angeles, California, USA. Supported by grants from the US Department of Health and Human Services, National Institutes of Health (NIH), National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), P01-052915-06 and from the Spondylitis Association of America. We acknowledge the support provided by the Biostatistics/Epidemiology/Research Design component of the Center for Clinical and Translational Sciences (CCTS) for this project. CCTS is mainly funded by the NIH Centers for Translational Science Award (UL1TR000371) by the National Center for Advancing Translational Sciences (NCATS). Management of data for our study was done using REDCap, which was partly supported by a grant UL1 TR000445 from NCATS/NIH, awarded to Vanderbilt University. Dr. M. Ward is supported by the Intramural Research Program, NIAMS, NIH. Dr. L. Gensler is supported by the Russell/Engleman Rheumatology Research Center at UCSF. J.D. Dau, MD, Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center Houston; M.J. Lee, PhD, Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston; M.M. Ward, MD, MPH, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health; L.S. Gensler, MD, Department of Medicine, Division of Rheumatology, UCSF; M.A. Brown, FRACP, University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital, and Institute of Health and Biomedical Innovation, Queensland University of Technology, Translational Research Institute, Princess Alexandra Hospital; T.J. Learch, MD, Division of Rheumatology, Cedars Sinai Medical Center; L.A. Diekman, MS, Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center Houston; A. Tahanan, BS, Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston; M.H. Rahbar, PhD, Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston; M.H. Weisman, MD, Division of Rheumatology, Cedars Sinai Medical Center; J.D. Reveille, MD, Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center Houston. Address correspondence to Dr. J.D. Reveille, McGovern Medical School at the University of Texas Health Science Center Houston, 6431 Fannin, Houston, Texas 77030, USA. E-mail: John.D.Reveille@uth.tmc.edu. Accepted for publication September 8, 2017.
Michael H. Weisman
From the Department of Internal Medicine, Division of Rheumatology, and the Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston, Houston, Texas; National Institute of Arthritis and Musculoskeletal and Skin Diseases, US National Institutes of Health, Bethesda, Maryland; Department of Medicine, Division of Rheumatology, University of California San Francisco (UCSF), San Francisco, California, USA; University of Queensland Diamantina Institute, Translational Research Institute, and Institute of Health and Biomedical Innovation, Queensland University of Technology, Princess Alexandra Hospital, Queensland, Australia; Division of Rheumatology, Cedars Sinai Medical Center, Los Angeles, California, USA. Supported by grants from the US Department of Health and Human Services, National Institutes of Health (NIH), National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), P01-052915-06 and from the Spondylitis Association of America. We acknowledge the support provided by the Biostatistics/Epidemiology/Research Design component of the Center for Clinical and Translational Sciences (CCTS) for this project. CCTS is mainly funded by the NIH Centers for Translational Science Award (UL1TR000371) by the National Center for Advancing Translational Sciences (NCATS). Management of data for our study was done using REDCap, which was partly supported by a grant UL1 TR000445 from NCATS/NIH, awarded to Vanderbilt University. Dr. M. Ward is supported by the Intramural Research Program, NIAMS, NIH. Dr. L. Gensler is supported by the Russell/Engleman Rheumatology Research Center at UCSF. J.D. Dau, MD, Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center Houston; M.J. Lee, PhD, Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston; M.M. Ward, MD, MPH, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health; L.S. Gensler, MD, Department of Medicine, Division of Rheumatology, UCSF; M.A. Brown, FRACP, University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital, and Institute of Health and Biomedical Innovation, Queensland University of Technology, Translational Research Institute, Princess Alexandra Hospital; T.J. Learch, MD, Division of Rheumatology, Cedars Sinai Medical Center; L.A. Diekman, MS, Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center Houston; A. Tahanan, BS, Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston; M.H. Rahbar, PhD, Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston; M.H. Weisman, MD, Division of Rheumatology, Cedars Sinai Medical Center; J.D. Reveille, MD, Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center Houston. Address correspondence to Dr. J.D. Reveille, McGovern Medical School at the University of Texas Health Science Center Houston, 6431 Fannin, Houston, Texas 77030, USA. E-mail: John.D.Reveille@uth.tmc.edu. Accepted for publication September 8, 2017.
John D. Reveille
From the Department of Internal Medicine, Division of Rheumatology, and the Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston, Houston, Texas; National Institute of Arthritis and Musculoskeletal and Skin Diseases, US National Institutes of Health, Bethesda, Maryland; Department of Medicine, Division of Rheumatology, University of California San Francisco (UCSF), San Francisco, California, USA; University of Queensland Diamantina Institute, Translational Research Institute, and Institute of Health and Biomedical Innovation, Queensland University of Technology, Princess Alexandra Hospital, Queensland, Australia; Division of Rheumatology, Cedars Sinai Medical Center, Los Angeles, California, USA. Supported by grants from the US Department of Health and Human Services, National Institutes of Health (NIH), National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), P01-052915-06 and from the Spondylitis Association of America. We acknowledge the support provided by the Biostatistics/Epidemiology/Research Design component of the Center for Clinical and Translational Sciences (CCTS) for this project. CCTS is mainly funded by the NIH Centers for Translational Science Award (UL1TR000371) by the National Center for Advancing Translational Sciences (NCATS). Management of data for our study was done using REDCap, which was partly supported by a grant UL1 TR000445 from NCATS/NIH, awarded to Vanderbilt University. Dr. M. Ward is supported by the Intramural Research Program, NIAMS, NIH. Dr. L. Gensler is supported by the Russell/Engleman Rheumatology Research Center at UCSF. J.D. Dau, MD, Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center Houston; M.J. Lee, PhD, Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston; M.M. Ward, MD, MPH, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health; L.S. Gensler, MD, Department of Medicine, Division of Rheumatology, UCSF; M.A. Brown, FRACP, University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital, and Institute of Health and Biomedical Innovation, Queensland University of Technology, Translational Research Institute, Princess Alexandra Hospital; T.J. Learch, MD, Division of Rheumatology, Cedars Sinai Medical Center; L.A. Diekman, MS, Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center Houston; A. Tahanan, BS, Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston; M.H. Rahbar, PhD, Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston; M.H. Weisman, MD, Division of Rheumatology, Cedars Sinai Medical Center; J.D. Reveille, MD, Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center Houston. Address correspondence to Dr. J.D. Reveille, McGovern Medical School at the University of Texas Health Science Center Houston, 6431 Fannin, Houston, Texas 77030, USA. E-mail: John.D.Reveille@uth.tmc.edu. Accepted for publication September 8, 2017.
Abstract
Objective Opioid analgesics may be prescribed to ankylosing spondylitis (AS) patients with pain that is unresponsive to antirheumatic treatment. Our study assessed factors associated with opioid usage in AS.
Methods A prospective cohort of 706 patients with AS meeting modified New York criteria followed at least 2 years underwent comprehensive clinical evaluation of disease activity and functional impairment. These were assessed by the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Bath Ankylosing Spondylitis Functional Index (BASFI). Radiographic severity was assessed by the Bath Ankylosing Spondylitis Radiology Index and modified Stokes Ankylosing Spondylitis Scoring System. Medications taken concurrently with opioids, as well as C-reactive protein (CRP) levels and erythrocyte sedimentation rate (ESR), were determined at each study visit, performed every 6 months. Analyses were carried out at baseline, and longitudinal multivariable models were developed to identify factors independently associated with chronic and intermittent opioid usage over time.
Results Factors significantly associated with opioid usage, especially chronic opioid use, included longer disease duration, smoking, lack of exercise, higher disease activity (BASDAI) and functional impairment (BASFI), depression, radiographic severity, and cardiovascular disease. Patients taking opioids were more likely to be using anxiolytic, hypnotic, antidepressant, and muscle relaxant medications. Multivariable analysis underscored the association with smoking, older age, antitumor necrosis factor agent use, and psychoactive drugs, as well as with subjective but not objective determinants of disease activity.
Conclusion Opioid usage was more likely to be associated with subjective measures (depression, BASDAI, BASFI) than objective measures (CRP, ESR), suggesting that pain in AS may derive from sources other than spinal inflammation alone.
In this issue
The Journal of Rheumatology
Vol. 50, Issue 3
1 Mar 2023
Opioid Analgesic Use in Patients with Ankylosing Spondylitis: An Analysis of the Prospective Study of Outcomes in an Ankylosing Spondylitis Cohort
Jonathan D. Dau, MinJae Lee, Michael M. Ward, Lianne S. Gensler, Matthew A. Brown, Thomas J. Learch, Laura A. Diekman, Amirali Tahanan, Mohammad H. Rahbar, Michael H. Weisman, John D. Reveille
The Journal of Rheumatology Dec 2017, jrheum.170630; DOI: 10.3899/jrheum.170630
Opioid Analgesic Use in Patients with Ankylosing Spondylitis: An Analysis of the Prospective Study of Outcomes in an Ankylosing Spondylitis Cohort
Jonathan D. Dau, MinJae Lee, Michael M. Ward, Lianne S. Gensler, Matthew A. Brown, Thomas J. Learch, Laura A. Diekman, Amirali Tahanan, Mohammad H. Rahbar, Michael H. Weisman, John D. Reveille
The Journal of Rheumatology Dec 2017, jrheum.170630; DOI: 10.3899/jrheum.170630
