New research led by Keele University and published in the journal BMC Medicine has shown that people with inflammatory arthritis currently using gabapentinoids are more likely to break their bones. 

Inflammatory arthritis (IA) refers to conditions causing joint inflammation, such as rheumatoid arthritis and psoriatic arthritis. It is common, affecting over 1 in 100 adults in England.  

Many people with IA suffer long-term pain and are prescribed painkillers, despite their limited effectiveness in inflammatory arthritis. The number of people with IA in England who are prescribed gabapentinoids - a type of medicine widely believed to help long-term pain - has increased significantly in the last decade, with 1 in 10 people with IA prescribed a gabapentinoid in 2020, despite no clinical trials having been undertaken to show they help pain in inflammatory arthritis. 

Some studies suggest that people using gabapentinoids may be more likely to break their bones compared to people not using gabapentinoids. This is particularly concerning for people with inflammatory arthritis, who are already more likely to suffer fractures.  

However, as people taking gabapentinoids may differ from people not taking gabapentinoids - for example, they could be older - and it is these differences that make them more likely to break their bones, further research has been needed. 

To address this, researchers from Keele University, funded by the National Institute for Health and Care Research (NIHR), used an alternative method to look at the association between fractures and gabapentinoids in people with IA.  

They looked at whether people with IA that are currently using a gabapentinoid are more likely to break their bones compared to people that have used one in the past. As all of these people have used a gabapentinoid at some point, this reduces the chance that fractures may be due to other differences between these groups. 

The researchers looked at anonymised medical records from people with IA treated across England from 2004 to 2021. They found that people with inflammatory arthritis currently receiving a gabapentinoid were 36% more likely to have a fracture, compared to those receiving a gabapentinoid in the more distant past. 

Lead author Dr Ian Scott, Reader in Rheumatology at Keele, said: “Our study has shown a modest association between the current use of gabapentinoids and bone fractures in people with inflammatory arthritis. All medicines have possible benefits and harms. As our study is not a clinical trial, we cannot be certain that gabapentinoids do increase the chances of people with inflammatory arthritis having a fracture.  

“However, when our results are considered against the lack of research evidence that gabapentinoids help pain in people with inflammatory arthritis, and the other known harms of these medicines, they do call into question the common practice of prescribing gabapentinoids to manage pain in people with inflammatory arthritis.”