Pain management, prolonged opioid use, initiated anti-rheumatic treatment and psychiatric morbidity in new-onset psoriatic arthritis

Abstract

Objectives: To explore the use of DMARDs and painkillers in incident PsA patients. Methods: From the Finnish Social Insurance Institution register we collected all adult patients granted a special reimbursement (SR) for DMARDs for PsA from 1 January 2010 to 31 December 2014 (N = 2678). For each case, three general population controls were matched. The purchases of painkillers, antidepressants, anxiolytics and hypnotics were analysed 1 year before and after the index date (ID; the date the SR was granted) and DMARDs at the ID and 1 year before it. Results: The year preceding the ID, 51% of the patients purchased any DMARDs, with 31% being MTX. Nevertheless, on the ID the respective percentages increased to 95% and 71%. PsA patients purchased all painkillers significantly more often than their controls before the ID and the purchases peaked at the ID. After that, the purchases of paracetamol and NSAIDs decreased but those of opioids remained at almost the same level. PsA patients purchased antidepressants and hypnotics more often than their controls. The use of the antidepressants, anxiolytics, hypnotics and opioids before the ID was associated with the risk of prolonged opioid use. Conclusion: A substantial proportion of incident PsA patients are purchasing DMARDs before the ID, which may reflect the difficulty of setting a PsA diagnosis or may represent the treatment of severe skin psoriasis. PsA patients use more painkillers than their matched controls 1 year preceding the diagnosis. Prolonged opioid use is particularly evident among patients using psychiatric medications.