Tags

Type your tag names separated by a space and hit enter

The efficacy and safety of opioids in inflammatory arthritis: a Cochrane systematic review.
J Rheumatol Suppl. 2012 Sep; 90:40-6.JR

Abstract

OBJECTIVE

To determine the efficacy and safety of opioid analgesics in inflammatory arthritis (IA).

METHODS

We searched Medline, Embase, and Central to May 2010. Randomized controlled trials in adults with IA that compared opioids (administered via any route) to another intervention or placebo were included. Studies in the immediate postoperative setting were excluded. Two authors independently extracted data and assessed risk of bias. Primary endpoints were pain and adverse events (AE). Categorical data were pooled using RevMan5 and reported as relative risks (RR) or odds ratios (OR) with 95% confidence intervals (95% CI).

RESULTS

Eleven studies were included, all in patients with RA. The risk of bias of all studies was high. No study was longer than 6 weeks in duration and 4 studies used single doses of study drugs. Seven studies were between 1 and 6 weeks in duration and assessed 6 different oral opioids. Only 1 study investigated a strong opioid. Data could be pooled from 4 studies comparing weak opioids to placebo: there was no difference in withdrawals due to inadequate analgesia (RR 0.82, 95% CI 0.34, 2.01), but patient-reported global impression of change was superior with opioids (RR 1.44, 95% CI 1.03, 2.03). Opioids were more likely than placebo to cause AE (OR 3.90, 95% CI 2.31, 6.56). There was no difference between opioids and placebo in net efficacy after adjustment for AE.

CONCLUSION

Based on 11 heterogeneous studies of short duration and high risk of bias, there is weak evidence that opioids are effective analgesics in RA. AE are common and may offset the benefits. The relative risks and benefits of opioids in IA beyond 6 weeks are unknown.

Authors+Show Affiliations

Rheumatology Unit, The Queen Elizabeth Hospital, 28 Woodville Road, Woodville South, South Australia 5011, Australia. Samuel.Whittle@health.sa.gov.auNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Review
Systematic Review

Language

eng

PubMed ID

22942328

Citation

Whittle, Samuel L., et al. "The Efficacy and Safety of Opioids in Inflammatory Arthritis: a Cochrane Systematic Review." The Journal of Rheumatology. Supplement, vol. 90, 2012, pp. 40-6.
Whittle SL, Richards BL, van der Heijde DM, et al. The efficacy and safety of opioids in inflammatory arthritis: a Cochrane systematic review. J Rheumatol Suppl. 2012;90:40-6.
Whittle, S. L., Richards, B. L., van der Heijde, D. M., & Buchbinder, R. (2012). The efficacy and safety of opioids in inflammatory arthritis: a Cochrane systematic review. The Journal of Rheumatology. Supplement, 90, 40-6. https://doi.org/10.3899/jrheum.120341
Whittle SL, et al. The Efficacy and Safety of Opioids in Inflammatory Arthritis: a Cochrane Systematic Review. J Rheumatol Suppl. 2012;90:40-6. PubMed PMID: 22942328.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The efficacy and safety of opioids in inflammatory arthritis: a Cochrane systematic review. AU - Whittle,Samuel L, AU - Richards,Bethan L, AU - van der Heijde,Désirée M, AU - Buchbinder,Rachelle, PY - 2012/9/4/entrez PY - 2012/9/4/pubmed PY - 2013/1/18/medline SP - 40 EP - 6 JF - The Journal of rheumatology. Supplement JO - J Rheumatol Suppl VL - 90 N2 - OBJECTIVE: To determine the efficacy and safety of opioid analgesics in inflammatory arthritis (IA). METHODS: We searched Medline, Embase, and Central to May 2010. Randomized controlled trials in adults with IA that compared opioids (administered via any route) to another intervention or placebo were included. Studies in the immediate postoperative setting were excluded. Two authors independently extracted data and assessed risk of bias. Primary endpoints were pain and adverse events (AE). Categorical data were pooled using RevMan5 and reported as relative risks (RR) or odds ratios (OR) with 95% confidence intervals (95% CI). RESULTS: Eleven studies were included, all in patients with RA. The risk of bias of all studies was high. No study was longer than 6 weeks in duration and 4 studies used single doses of study drugs. Seven studies were between 1 and 6 weeks in duration and assessed 6 different oral opioids. Only 1 study investigated a strong opioid. Data could be pooled from 4 studies comparing weak opioids to placebo: there was no difference in withdrawals due to inadequate analgesia (RR 0.82, 95% CI 0.34, 2.01), but patient-reported global impression of change was superior with opioids (RR 1.44, 95% CI 1.03, 2.03). Opioids were more likely than placebo to cause AE (OR 3.90, 95% CI 2.31, 6.56). There was no difference between opioids and placebo in net efficacy after adjustment for AE. CONCLUSION: Based on 11 heterogeneous studies of short duration and high risk of bias, there is weak evidence that opioids are effective analgesics in RA. AE are common and may offset the benefits. The relative risks and benefits of opioids in IA beyond 6 weeks are unknown. SN - 0380-0903 UR - https://www.unboundmedicine.com/medline/citation/22942328/The_efficacy_and_safety_of_opioids_in_inflammatory_arthritis:_a_Cochrane_systematic_review_ L2 - http://www.jrheum.org/cgi/pmidlookup?view=long&pmid=22942328 DB - PRIME DP - Unbound Medicine ER -