American College of Rheumatology Annual Meeting

American College of Rheumatology Annual Meeting

November 12, 2019
2 min read

Opioid-related hospitalizations surge for rheumatic diseases, rise led by OA, fibromyalgia, RA

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Jasvinder Singh

ATLANTA — The incidence of opioid-related hospitalizations among patients with musculoskeletal conditions increased markedly over the past 2 decades, with continued growth among patients with osteoarthritis, rheumatoid arthritis and fibromyalgia, according to a presentation at the 2019 ACR/ARP Annual Meeting.

“We were interested in looking at opioids use disorder [OUD] in the five common musculoskeletal disorders, given the opioid epidemic in the United States,” Jasvinder Singh, MD, MPH, from the division of rheumatology and clinical immunology at the University of Alabama at Birmingham, said during a press conference. “Among all conditions, musculoskeletal pain disorders are one of the most common reasons that patients receive opioids, outside of cancer. With that in mind, we were interested in one aspect of opioid use disorder, namely associated hospitalizations in the U.S.”

To determine the rate of OUD-related hospitalizations among patients with musculoskeletal diseases, Singh and colleagues examined the U.S. National Inpatient Sample (NIS) data from 1998 to 2014 for patients with gout, OA, RA, fibromyalgia and low back pain.

The researchers based their retrospective review on the ICD-9-CM diagnostic codes for opioid dependence or abuse in the primary diagnosis position: 304.0x, 304.7x, 305.5x, 965.0x, E850.0 or E935.05. The incidence of OUD claims was assessed per 100,000 total NIS claims.

According to study results, although the incidence of OUD-related hospitalizations was low at the start of the study period, there were significant increases across all five conditions over 19 years, with a 24-fold increase in hospitalizations among patients with gout, ninefold increase in OA, eightfold increase in fibromyalgia, sixfold increase in RA and a nearly fourfold increase among patients with low back pain.

“We also found that in patients with gout, the hospital charges were about $3000 higher and the odds of being hospitalized for more than 3 days was about 25% higher — we did not observe similar rates across the other four conditions,” Singh said. “[Another interesting aspect] is that if you compare each of the five musculoskeletal disease cohorts to people without these conditions, the mortality for OUD hospitalization was much lower among patients with musculoskeletal diseases than those without it, and we aren’t sure what the cause could be.”

According to the researchers, the rates of OUD per 100,000 NIS claims overall demonstrated significant increases in hospitalization; among patients with low back pain, hospitalization rates increased 554% whereas patients with gout exhibited a 3,568% increased rate of hospitalization.

Singh also noted that although there appeared to be a plateau of OUD claims for low back pain and gout, “the increase seems to continue for OA, fibromyalgia and RA.”

“We believe that our study might help our colleagues get an insight into rates and time-trends in OUD hospitalization and allow comparison across various conditions,” Singh said. “We hope that in years to come, we can accumulate more data and hopefully observe a decline in OUD hospitalization across all of these conditions.” – by Robert Stott

Singh J. Abstract #2047. Time-trends in opioid use hospitalizations in common musculoskeletal conditions: Gout, osteoarthritis, rheumatoid arthritis, fibromyalgia, and low back pain. Presented at ACR/ARP Annual Meeting, Nov. 8-13, 2019; Atlanta.

Disclosure: Singh reports consulting fees from Clinical Care Options, Clearview Healthcare Partners, Horizon, Medisys, Putnam Associates, Spherix and WebMD, as well as ownership of stock options in Amarin Pharmaceuticals and Viking Therapeutics.