OP0216 Examining modifiable psychological & social health factors associated with use of osteoarthritis oral analgesic treatment
Authors: E.R. Vina, L. Hausmann, D.S. Obrosky, A. Youk, D. Weiner, S. Ibrahim, C.K. Kwoh
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> EULAR recommends the use of non-opioid oral medicines (acetaminophen, NSAIDs, or COX-2 inhibitors) for the management of knee osteoarthritis (OA). Opioids are also recommended when these other therapies fail. There are known demographic and clinical differences in OA treatment use. Patients' social and psychological health may also influence use of medications, yet their association with the utilisation of opioid or non-opioid oral OA treatments is unknown. <h3>Objectives</h3> Determine which modifiable social and psychological health factors are associated with use of oral opioid and non-opioid medications for OA. <h3>Methods</h3> Baseline data from a randomised controlled trial that examined the effects of a positive psychological intervention on pain in veterans with knee OA were used. For our study, patients were categorised based on self-reported use of the following oral medications for OA at baseline: opioids (with/without other oral analgesic treatments), non-opioid analgesics, and no oral analgesic treatment. We used χ<sup>2</sup> or analysis of variance to compare sociodemographic, clinical, social, and psychological health variables by baseline OA treatment use. We used multinomial logistic regression models to estimate adjusted relative risk ratios (RRRs) of using an opioid or a non-opioid analgesic (vs. no oral analgesic treatment), comparing patients by levels of social support (Medical Outcomes Study), health literacy ('How confident are you filling out medical forms by yourself'), and depressive symptoms (Patient Health Questionnaire-8). All models were adjusted for age, sex, race, income, OA symptom severity (WOMAC), self-reported Charlson comorbidity index, and body mass index. <h3>Results</h3> In this sample, 30.6% (n=110) reported taking opioid analgesics for OA, 54.2% (n=195) reported non-opioid use, and 15.3% (n=55) reported no oral analgesic use. Compared to the other groups, those taking opioids were younger (mean age 62.5 vs 64.3 vs 67.1, respectively, p=0.002) and had higher mean WOMAC scores (54.5 vs 45.7 vs 42.7, p&lt;0.001). Opioid users also had lower mean social support scores (10.0 vs 10.5 vs 11.9, p=0.007) and were more likely to have moderate-severe depression (42.7% vs 24.1% vs 14.5%, p&lt;0.001). Having adequate health literacy did not differ by treatment group type. The table 1 shows the associations between the social and psychological health measures with oral analgesic use, adjusted for sociodemographic and clinical factors. Having moderate-severe depression was associated with higher risk of opioid analgesic use compared to no oral analgesic use (RRR 2.96, 95% CI: 1.08 to 8.07) when adjusted for sociodemographic and clinical factors. Depression level was not significantly associated with non-opioid oral medication use, compared to no oral analgesic medication use, in a similarly adjusted model. Neither social support nor health literacy was associated with opioid or non-opioid oral analgesic use in fully adjusted models. <h3>Conclusions</h3> Knee OA patients with more severe depression symptoms, compared to those without, were more likely to report using opioid (vs. non-opioid) analgesics for OA. Social support and health literacy were not significantly associated with oral analgesic use for OA when sociodemographic and clinical factors were accounted for. <h3>Disclosure of Interest</h3> E. Vina: None declared, L. Hausmann: None declared, D. Obrosky: None declared, A. Youk: None declared, D. Weiner: None declared, S. Ibrahim: None declared, C. Kwoh Grant/research support from: Abbvie, EMD Serono, Consultant for: Astellas, EMD Serono, Thusane, Express Scripts, Novartis