Analgesia Prescribing in Patients with Inflammatory Arthritis in England: An Observational Study Using Electronic Healthcare Record Data.

OBJECTIVES International data suggest inflammatory arthritis (IA) pain management frequently involves opioid prescribing, despite little evidence of efficacy, and potential harms. We evaluated analgesia prescribing in English National Health Service-managed patients with IA. METHODS Repeated cross-sectional analyses in the Consultations in Primary Care Archive (primary care consultation/prescription data in 9 general practices from 2000-2015) evaluated the annual prevalence of analgesia prescriptions in: (a) IA cases (rheumatoid arthritis [RA]/psoriatic arthritis [PsA]/axial spondyloarthritis [SpA]), and (b) up-to five age/sex/practice-matched controls. Analgesia prescriptions were classified into basic/opioids/gabapentinoids/oral non-steroidal anti-inflammatory drugs (NSAIDs), and sub-classified into chronic and intermittent (≥3 and 1-2 prescriptions/calendar-year, respectively). RESULTS In 2000, there were 594 cases/2,652 controls, rising to 1,080 cases/4,703 controls in 2015. In all years, most (65.3-78.5%) cases received analgesia, compared with fewer (37.5-41.1%) controls. Opioid prescribing in cases fell between 2000-2015 but remained common with 45.4% (95% confidence interval [CI] 42.4%, 48.4%) and 32.9% (95% CI 29.8%, 36.0%) receiving at least 1 and ≥3 opioid prescriptions, respectively in 2015. Gabapentinoid prescription prevalence in cases increased from 0% in 2000, to 9.5% (95% CI 7.9%, 11.4%) in 2015, and oral NSAID prescription prevalence fell from 53.7% (95% CI 49.6%, 57.8%) in 2000, to 25.0% (95% CI 22.4%, 27.7%) in 2015. Across years, analgesia prescribing was commoner in RA than PsA/axial SpA, and 1.7-2.0 times higher in cases than controls. CONCLUSIONS Analgesia prescribing in IA is common. This is at variance with existing evidence of analgesia efficacy/risks, and guidelines. Interventions are needed to improve analgesia prescribing in this population.