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Researchers from Vanderbilt University have studied the issue of opioid use in rheumatoid arthritis (RA) and whether this influences infection risk. Based on animal data, researchers have postulated that opioids may further immunosuppress those treated. (Citation source http://buff.ly/1QSPiGJ)
Self-controlled case series analysis of 13,796 RA patients enrolled in Tennessee Medicaid between 1995-2009 looked at the risk of hospitalizations for serious infections during periods of opioid use compared with non-use. These serious infections included pneumonia, meningitis, encephalitis, septicemia and other serious infections.
They found 1,790 RA patients with at least one hospitalization for serious infection, and the adjusted incidence rate of serious infection was higher during periods of current opioid use [incidence rate ratio (IRR: 1.39; 95% CI: 1.19-1.62). The incidence rate was also higher during periods of long-acting opioid use, immunosuppressive opioid use and new opioid use compared with non-use. (These results were adjusted for confounders - age, DMARDs, glucocorticoids, and proton-pump inhibitors.)
RA patients on opioids may have a 40% increased risk of serious infections leading hospitalizations. Whether these are direct or indirect effects was not addressed in these analyses.