Opioids Linked to Greater Infection Risk in RA Patients

A new study finds that the use of opioid analgesics is linked to an increased risk for hospitalizations due to serious infections among rheumatoid arthritis (RA) patients.

In an effort to compare the rate of serious infections during periods of opioid use versus periods in which opioids were not used, a team of Vanderbilt University Medical Center researchers led by Andrew Wiese, MPH, a graduate research assistant at the school, evaluated 1,790 RA patients who were enrolled in Tennessee Medicaid. Wiese and colleagues tracked infections including pneumonia, meningitis, encephalitis, and septicemia.
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After accounting for potential confounding factors, the authors found that periods of opioid use were connected to an almost 40% increase in the rate of serious infections compared to periods of no opioid use, according to Wiese, who notes that RA patients are already at high risk for serious infections and commonly use opioid analgesics for pain management purposes.

“Patients with rheumatoid arthritis are at increased risk of infections from the disease itself and from the use of immunosuppressive medications to control disease activity,” says Wiese, noting that these patients sometimes use pain control medications, including opioid analgesics.

“Our understanding of the safety profile of these medications is incomplete. Some studies done in vitro or in animal models suggest that some opioids can affect the cells of the immune system and reduce their ability to fight infections,” he continues.

The clinical implications of these observations for humans, however, are unknown, says Wiese.

“Our study found that periods of opioid use were associated with an increased risk for serious infections among patients with rheumatoid arthritis, which lends support to the idea that opioids might cause further immunosuppression in these patients,” he says. “We believe that not all opioids have the same potential for immunosuppression, and additional assessments are needed to examine specific opioids and formulations that may be particularly problematic. This information could inform the selection of appropriate pain control medications in susceptible populations.”

—Mark McGraw

Reference

Wiese A, Griffin R, et al. Opioid analgesics and the risk of serious infections among patients with rheumatoid arthritis: A self-controlled case series study. Arthritis & Rheumatology. 2015.