TOPLINE

More than 40% of older adults with rheumatic diseases filled at least one opioid prescription in 2021, and about 18% met the criteria for chronic opioid use. Patients with axial spondyloarthritis (axSpA) and those living in the most socioeconomically deprived areas had elevated odds of chronic use.

METHODOLOGY

• Researchers conducted a cross-sectional analysis of the Rheumatology Informatics System for Effectiveness (RISE) registry linked to Medicare data to estimate opioid exposure in older adults (aged ≥ 65 years) with rheumatic diseases.
• The analysis included 45,455 patients (mean age, 75.8 years; 76.88% women) with a qualifying rheumatic disease diagnosis who had continuous Medicare Part D enrollment and visited a RISE practice at least twice in 2021.
• Qualifying diseases included rheumatoid arthritis (RA), osteoarthritis, psoriatic arthritis, systemic lupus erythematosus (SLE), axSpA, Sjögren disease, systemic sclerosis, polymyalgia rheumatica, and gout.
• Chronic opioid use was defined as at least 90 days' supply of opioids in 2021. High-risk indicators included a maximum 90-day average morphine equivalent dose (MED) ≥ 120 mg, an average yearly MED ≥ 240 mg, and a maximum 90-day average MED ≥ 120 mg combined with claims from at least four different prescribers.
• Neighborhood-level socioeconomic disadvantage was measured using the Area Deprivation Index (ADI) and was analyzed in quartiles.

TAKEAWAY

• Overall, 43.13% of patients had at least one opioid claim in 2021, and 17.93% met the criteria for chronic opioid use. Among those with any opioid claim, the mean maximum 90-day average MED was 17.1 mg.
• The majority (62.60%) of opioid claims were written by clinicians not affiliated with rheumatology, whereas about a third of opioid claims (33.36%) were written exclusively by rheumatology-affiliated clinicians. 
• Compared with patients with RA, the odds of chronic opioid use were higher in those with axSpA (adjusted odds ratio [aOR], 1.63; 95% CI, 1.35-1.98) and lower in those with SLE (aOR, 0.77; 95% CI, 0.67-0.88), polymyalgia rheumatica (aOR, 0.62; 95% CI, 0.52-0.73), and systemic sclerosis (aOR, 0.71; 95% CI, 0.53-0.94).
• Patients in the highest quartile of deprivation had higher odds of chronic opioid use than those in the lowest quartile (aOR, 1.91; 95% CI, 1.71-2.13). Fibromyalgia, mood disorder, anxiety disorder, and higher comorbidity scores were independently linked to higher odds of chronic opioid use.

IN PRACTICE

"[T]he findings indicate that opioid prescribing commonly occurred outside rheumatology. Efforts to reduce avoidable chronic opioid exposure may therefore benefit from coordinated, cross-specialty approaches, such as shared care models and improved communication," the authors of the study wrote.

SOURCE

The study was led by Christine Anastasiou, MD, MAS, Stanford University, Palo Alto, California. It was published online on October 15, 2026, in The Journal of Rheumatology.

LIMITATIONS

The study lacked direct measurements of pain intensity, function, and disease activity, and it relied on dispensing claims that might not have accurately reflected whether patients took the drugs. The ADI may have misclassified individual socioeconomic circumstances. The 2021 data were obtained during the COVID pandemic, when care disruptions may have affected prescribing trends.

DISCLOSURES

The study received funding from the Rheumatology Research Foundation, the Agency for Healthcare Research and Quality, and the National Institute of Arthritis and Musculoskeletal and Skin Diseases at the National Institutes of Health. One author reported receiving consulting fees from Emergent Biosciences unrelated to this work. Another author disclosed receiving consulting fees from AstraZeneca and UCB, as well as grant funding from AstraZeneca, Gilead, and Aurinia, all unrelated to this work. 

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.