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Depression tied to opiate use in ankylosing spondylitis.


NEW YORK -- Patients with ankylosing spondylitis who used opiate analgesics were five times more likely to report depression than were those who did not, in a retrospective case-control study of 611 patients.

The relationship between opiate usage and depression was significant even though those who took antidepressants or anxiolytics were significantly less likely to use opiates, according to Dr. Jonathan D. Dau of the department of rheumatology at the University of Texas, Houston.

In the study, there were several highly significant distinctions between those who used opiate analgesics and those who did not, but none could be connected to inflammatory activity.

"None of the objective measures of AS [ankylosing spondylitis] disease activity or progression were found to be associated with opiate usage. This adds confirmation to the hypothesis that pain associated with AS may develop from sources other than spinal inflammation alone," he said.

In data presented at the joint meetings of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis and the Spondyloarthritis Research & Treatment Network, a large variety of parameters were compared between the 87 patients who took opiate analgesics intermittently (91%) or continuously (9%) and the remaining 524 who never took opiate analgesics over a follow-up period of up to 4 years. Three centers in addition to the University of Texas contributed AS patients to the analysis. The mean disease duration was 17.6 years.

Although there were no significant differences between users and nonusers of opiates for radiographic severity, as measured with the modified Stoke Ankylosing Spondylitis Spinal Score, or inflammation, as measured with C-reactive protein levels or erythrocyte sedimentation rate, opiate users scored high on subjective measures. Specifically, the odds ratio for a Bath AS Disease Activity Index score of 4 or greater was 5.460 (P less than .0001). The OR for a high patient global pain assessment was 4.240 (P less than .0001).


Key clinical point: Patients with ankylosing spondylitis who use opiates are far more likely to self-report depression than are those who do not use opiates, with declining use of opiates in those on antidepressants or anxiolytics.

Major finding: Depression was significantly more likely to occur among opiate users relative to nonopiate users by self-report (OR, 5.907; P less than .0001) and by the Center for Epidemiologic Study Depression scale (OR, 3.071; P less than .0001).

Data source: A retrospective, case-control study of 611 patients with AS.

Disclosures: Dr. Dau reported no relevant financial disclosures.

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Author:Bosworth, Ted
Publication:Clinical Psychiatry News
Date:Oct 1, 2014
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