Abstract Background/Aims Chronic pain is common in inflammatory arthritis (IA), with optimising its management a patient priority. Previous studies indicate that depression has a modest bidirectional relationship with pain, but its effect on pain-related healthcare use is unknown. We examined this using CPRD Aurum (a primary care electronic health record database, covering approximately 20% of England), describing analgesic prescribing and musculoskeletal pain-related consultation rates in people with IA, with and without depression and anxiety. Methods Three observational studieswere conducted, including adults with rheumatoid arthritis (RA; n = 132,745), axialspondyloarthritis (AxSpA; n = 16,625), and psoriatic arthritis (PsA; n = 38,638)from 2012 to 2021. Outcomes comprised analgesic prescription prevalence andprimary care musculoskeletal pain-related consultation rates. Study onedescribed outcomes annually in people with/without depression, anxiety, ormixed depression/anxiety. Studies two and three used joinpoint regression toexplore whether outcome differences aligned temporally with a diagnosisof/pharmacological treatment for these mental health conditions, describingoutcomes quarterly two years pre-/post-mental health diagnosis (study two) orantidepressant/anxiolytic treatment (study three). Results Study one: strong opioid annual prescription prevalence was consistently higher in people with vs without depression (2021: 40.7/36.8/34.5% vs 25.7/22.4/21.9% in RA/AxSpA/PsA). The same was seen for basic analgesics/gabapentinoids, but not NSAIDs or weak/moderate opioids. Comparable findings were seen for mixed depression/anxiety, but not anxiety alone. Annual musculoskeletal pain-related consultation rates were consistently higher with vs without all mental health diagnoses (2021: depression 1.6/1.4/0.7 vs no depression 1.0/0.8/0.4 consults per year in RA/AxSpA/PsA). Trends persisted across age, gender, deprivation, and fibromyalgia presence/absence status. Study two: musculoskeletal pain-related consultation rates increased in the two years pre-depression diagnosis, declining in the two years after (quarterly prevalence change pre- vs post-diagnosis: +1.5/2.7/0.3% vs -3.8/5.3/8.1% in RA/AxSpA/PsA). Similar trends occurred for mixed depression/anxiety, with no differences for anxiety. Changes in strong opioid/gabapentinoid prescribing around mental health diagnosis timepoints were inconsistent across IA types. Study three: in RA and depression, increases in quarterly strong opioid prescription prevalence slowed around antidepressant initiation (+4.9% each quarter pre-treatment; +1.5% post-treatment). No consistent trends were seen for other IA types/mental health conditions/gabapentinoids. Across IA types and mixed depression/anxiety, quarterly musculoskeletal pain-related consultation rates declined around antidepressant/anxiolytic initiation (+6.0/17.9/17.9% in RA/PsA/AxSpA quarterly pre-treatment and -7.9/4.6/4.6% post-treatment). No changes were seen for depression or anxiety alone across the IA subtypes. Conclusion People with IA and depression have higher levels of strong opioid, gabapentinoid, and basic analgesic use and receive more MSK pain-related consultations. This appears independent of age, gender, fibromyalgia, and deprivation status. GP consultations for pain fell after a depression diagnosis, and after starting treatment for mixed depression/anxiety, suggesting that treating depression may reduce pain-related healthcare use. These findings support incorporating depression care into pain management in people with IA. Disclosure N. Cox: Grants/research support; NC recieved funding for this work from the Haywood Foundation and Keele Haywood Academic Rheumatology Group. S. Muller: Grants/research support; SM is partly funded by the NIHR Applied Research Collaboration West Midlands (NIHR200165). H. Twohig: Grants/research support; HT is an NIHR Clinical Lecturer. S. Farooq: Grants/research support; SF is an NIHR Global Research Professor. J. Bailey: None. I. Scott: Grants/research support; ICS is funded by the NIHR Advanced Research Fellowship (NIHR300826). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.
Cox et al. (Wed,) studied this question.
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