Frequent Opioid Usage Observed in Patients With Rheumatoid Arthritis and ILD

The prevalence and incidence of interstitial lung disease (ILD) in patients with rheumatoid arthritis (RA) did not change significantly over a 13-year period according to data derived from a German cohort study published in RMD Open.¹ However, therapies shifted from non-steroidal anti-inflammatory drugs (NSAIDs), conventional glucocorticoids (decreasing from 84% in 2007 to 68% in 2020), and conventional synthetic disease-modifying antirheumatic drugs (DMARDs) to biologic DMARDS (increasing from 16% in 2007 to 24% in 2020) and targeted synthetic DMARDs. The high opioid and analgesic demand in those with RA-ILD, a rare condition that mainly affects the elderly population, emphasizes continued unmet needs, such as experiencing sustained pain levels despite therapy.

In an accompanying Q&A with HCPLive, study coauthors Katinka Albrecht, MD, and Johanna Callhoff, MSc, both associated with Epidemiology and Health Services Research at the German Rheumatism Research Centre, discuss the results of their study evaluating RA-ILD.

What inspired your team to study the prevalence, incidence, and medication of ILD among patients with RA?

Interstitial lung disease is a rare but severe manifestation of rheumatoid arthritis and makes the therapeutic management of RA complex. Since there is not yet much evidence for a clear appropriate agent for these patients, we would like to provide rheumatologists with information on which drugs are commonly used and whether the available biologics have changed the prescription spectrum.

Results reported a high analgesic and opioid demand. Why do you think that is?

Many patients with rheumatoid arthritis continue to have pain despite therapy, and in case of the coexisting interstitial lung disease, some medications are used more cautiously. This can lead to insufficient suppression of the inflammatory activity of RA, which then can cause persistent severe joint pain.

Why do you believe patients are being treated with more biological and targeted synthetic DMARDs in recent years as opposed to NSAIDS, glucocorticoids, and conventional synthetic DMARDs?

Biologic DMARDs can be very effective in suppressing RA disease activity and often have a lower side effect profile than NSAIDs, glucocorticoids, and csDMARDs. Provided sufficient evidence is available to support their safety, biologic DMARDs are a very appropriate therapeutic option.

Did the results surprise you?

We were particularly surprised by the frequent opioid prescription in these patients.

What do rheumatologists need to know about RA-ILD when treating their patients?

The therapeutic approach should ideally be coordinated between rheumatologists and pulmonologists to treat RA sufficiently effective without further compromising or damaging lung function.

Are there any strengths or limitations of the study that you’d like to highlight?

The biggest strength of the study is that we included all persons with RA-ILD in the data, [including] those that were not in specialized rheumatologic or pulmologic care. Also, the information on medication was complete in these data- except for prescription-free over-the-counter medicine. Both of which was not the case in rheumatologic cohort studies. On the limitations side, we want to highlight that it was not possible to derive reliable information on disease activity from the claims data, so this information was missing. Also, health insurance diagnoses were not clinically validated, so we could not rule out some misdiagnoses in the cohort.

Does your team plan on doing any further research on the topic?

Our colleagues from the German biologics registry, RABBIT, are investigating the influence of different conventional synthetic and biologic DMARD therapies on the mortality of patients with RA and ILD.

Reference:

Albrecht K, Strangfeld A, Marschall U, Callhoff J. Interstitial lung disease in rheumatoid arthritis: incidence, prevalence and related drug prescriptions between 2007 and 2020. RMD Open. 2023;9(1):e002777. doi:10.1136/rmdopen-2022-002777