A team of Keele University researchers are calling for safer pain medicine prescribing in patients with inflammatory arthritis and urge a change in the way that pain in patients with this condition is treated.

The team carried out a study which found that up to three quarters of patients with inflammatory arthritis received a pain medicine prescription each year, with at least one in three receiving a long-term opioid prescription in each year.

Inflammatory arthritis, which affects around 1 in 100 people in England, groups together conditions causing joint inflammation arising from an overactive immune system, such as rheumatoid arthritis and psoriatic arthritis. Pain is a major challenge for patients with inflammatory arthritis, and despite the widespread availability of powerful medicines to treat joint inflammation, many patients with inflammatory arthritis still suffer significant pain.

The study, published in the Oxford University Press Rheumatology journal, looked at the prescribing of pain medicines in the medical records of over 1,000 people with inflammatory arthritis from 2000 to 2015. Apart from oral non-steroidal anti-inflammatory drugs (NSAIDs) in patients with spinal inflammation, previous research has shown only limited evidence that pain medicines may improve symptoms in some patients with inflammatory arthritis, and often have side-effects which can be severe.

The study also found that prescription rates for oral NSAIDs have fallen significantly since 2004. This coincides with a series of nationwide recommendations to prescribe them more safely, owing to the link some oral NSAIDs have with heart attacks and strokes.

Lead author Dr Ian Scott, Consultant Rheumatologist and Honorary Senior Lecturer in Keele University’s School of Medicine, said: “Our study has shown there is substantial and sustained prescribing of pain medicines, particularly of opioids, to patients with inflammatory arthritis in the English NHS. As there is generally only limited evidence that pain medicines may help inflammatory arthritis pain in some patients, but substantial evidence they can cause harm, this finding is concerning.”

“There are many other ways to help patients with inflammatory arthritis manage their pain. These include reducing joint inflammation using specialist disease-modifying medicines, exercise, and talking therapy treatments. Our study suggests we need to move the focus of pain care for people with inflammatory arthritis away from the long-term prescribing of pain medicines like opioids, and towards the use of these other treatment approaches.”