Study finds opioids double risk of venous thromboembolism in rheumatoid arthritis patients

Medical Xpress / American College of Rheumatology / ACR Convergence 2022 ^ | Nov. 8, 2022 | Gulsen Ozen, MD et al

[ConservativeMind]

New research found that adult RA patients starting opioids had twice the risk of venous thromboembolism (VTE) compared to patients starting nonsteroidal anti-inflammatory drugs (NSAIDs). Venous thromboembolism is a serious, but preventable, condition that occurs when a blood clot forms in a vein.

Pain management is a priority for most patients with rheumatoid arthritis (RA). Even with well-controlled disease, around 60% of patients continue to experience pain, with few safe pharmacological strategies, including NSAIDs and opioids, to help manage it. One concern with NSAIDs is the increased risk of major cardiovascular events, which is already heightened in patients with RA.

Although major cardiovascular incidents and all-cause mortality were lower among NSAID initiators compared to opioid initiators (392 and 228 vs. 133 and 95, respectively), the risk was similar in propensity score weighted models. The one exception was a two-fold increased risk of venous thromboembolism in the opioid group.

Dr. Ozen explains that while they didn't have data on why patients were hospitalized, data in the general public suggests that patients undergoing hip arthroplasty who are on long-term opioids have more venous thromboembolism events than non-users do.

Dr. Ozen notes that opioid prescribing in the rheumatology community decreased before the COVID-19 pandemic but has since ticked up and remains a problem for many patients with rheumatic diseases.

"Addressing pain in patients with rheumatoid arthritis is challenging as it is not always dependent on disease activity," Dr. Ozen says.

"Although we don't have direct evidence for patients with rheumatoid arthritis, we know from patients with osteoarthritis that chronic opioid use can intensify pain without improvement of function. Our study suggests that opioids can cause significant cardiovascular morbidity and even death in patients with rheumatoid arthritis."

[ConservativeMind]

There are issues with both the NSAIDs and opioids, but do note there are natural ways to minimize the inflammatory markers that rheumatoid (and osteo) arthritis cause.

Antioxidants, minerals like boron and even magnesium, along with lowering Omega-6 fats and increasing Omega-3 fats and getting good sleep, all of these, and more, are able to impact the inflammatory markers in rheumatoid arthritis. Exercise can help, as well. By reducing the inflammatory markers, you generally impact the pain.

Take the pain killers, but attack the pain from multiple angles.

[ConservativeMind]

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[ConservativeMind]

One study showing boron providing rheumatoid arthritis benefit:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5289089/

[EQAndyBuzz]

“Take the pain killers, but attack the pain from multiple angles.”

I stopped taking the opioids back in January when I had Covid. I found that 800mg of Advil does the same job, and eating foods with anti-inflammatory properties reduced a lot of the swelling. So far it has worked.