Opioid Side Effects May Increase Risk of Rheumatoid Arthritis Infections: Study

New research suggests that individuals with rheumatoid arthritis who are taking an opioid painkiller may face a higher risk of experiencing a potentially serious infection. 

In a study published late last month in the medical journal Arthritis & Rheumatology, researchers from Vanderbilt Medical Center found that side effects of opioids may include a risk of rheumatoid arthritis infections, as well as an increased risk of hospitalization as a result of the infection.

Researchers used medical data involving patients enrolled in Tennessee Medicaid between 1995 to 2009, which included an analysis of nearly 14,000 patients, finding 1,790 patients with rheumatoid arthritis who had at least one hospitalization for a serious infection.

More than 95% of the patients with rheumatoid arthritis used opioids at least once, compared to 87% use in the Medicaid group overall. Nearly half of the patients used hydrocodone, 22% used propoxyphene, 12% used Oxycodone, nearly six percent used morphine, five percent used codeine and six percent use other types of opioids.

Researchers found the risk of serious infection was higher during periods of current opioid drug use compared to non-use. The risk was also higher during periods of use of long-acting opioids and during immunosuppressive opioid use.

Rheumatoid arthritis is an autoimmune disorder that mostly affects a patient’s joints, causing swelling and pain. Swelling and pain often worsen following periods of rest. Patients may experience inflammation in the lungs and around the heart.

There is no cure for rheumatoid arthritis, so it is typically treated with painkillers, steroids and disease-modifying anti-rheumatic drugs (DMARDs).

Rheumatoid arthritis typically affects women over the age of 40 with few effective and satisfying treatments. With an older affected population, this also places them at risk of suffering severe side effects from the powerful medications they are taking to combat the condition, affecting the elderly more and more. The increased risk is thought to be associated with the autoimmune disease process itself.

This most recent study found that patients with rheumatoid arthritis using opioids have a risk of serious infections, but the risk was elevated if patients used immunosuppressive medications, glucocorticoids, proton-pump inhibitors and DMARDs, many drugs used to treat the condition.

The risk of infection was higher in patients during periods of current use of opioids and in patients using higher daily doses of opioids, and long acting formulations.

Opioid Abuse Concerns

In 2012, the CDC named prescription painkiller overdoses a “U.S. epidemic.” The report detailed the increasing numbers of overdose deaths by opioid and narcotic painkillers. The report noted opioid painkillers were responsible for more deaths than cocaine and heroin combined since 2003.

Another more recent CDC report found that women are affected by prescription painkiller abuse more than men. In 2013, the CDC reported that overdose deaths among women are on the rise in the U.S. The CDC found a 400% increase in overdose deaths caused by prescription pain medication among women since 1999.

However, a 2015 study suggests the country may be turning a corner on painkiller abuse. A study published in the New England Journal of Medicine found that rates of opioid painkiller use declined from 2011 to 2013.

The researchers said that the decline could be attributed to effective intervention and prevention programs launched to battle the drug abuse problem.