Opioids Raise Risk for VTE in Patients With Rheumatoid Arthritis

Opioid initiation among patients with rheumatoid arthritis (RA) is associated with similar major adverse cardiovascular events (MACE) and all-cause mortality risk versus nonsteroidal anti-inflammatory drug (NSAID) initiation; however, opioids did contribute to a higher risk for venous thromboembolism, according to a study presented at the annual meeting of the American College of Rheumatology, held from Nov. 10 to 14 in Philadelphia.

Gulsen Ozen, M.D., from the University of Nebraska Medical Center in Bellevue, and colleagues assessed MACE risk with opioids versus NSAIDs in patients with RA. The analysis included matched cohorts of 4,778 opioid-initiating and 11,218 NSAID-initiating RA patients (1998 to 2021).

The researchers found that during the study period, there were 133 MACE in the opioid-initiating group versus 392 in the NSAID group (18.2 versus 14.6 per 1,000 person-years). Similarly, all-cause deaths were higher in the opioid group (95 deaths) versus the NSAID group (228 deaths; 12.6 versus 8.2 per 1,000 person-years). While incidence rates of MACE and all-cause mortality were lower among NSAID initiators than opioid initiators, the risk for MACE was similar in propensity-matched models (hazard ratio, 1.05, 95 percent confidence interval, 0.83 to 1.32), as was all-cause mortality (hazard ratio, 1.21; 95 percent confidence interval, 0.91 to 1.62). The risk for venous thromboembolism was significantly higher in opioid initiators than NSAID initiators (hazard ratio, 2.45; 95 percent confidence interval, 1.27 to 4.74).

“We hope our findings can decrease opioid prescriptions for pain in patients with inflammatory rheumatic diseases,” Ozen said in a statement. “We have to remember that pain in inflammatory rheumatic diseases is multifactorial, and we should utilize nonpharmacological methods more often in this patient population.”

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