(030) Prevalence, characteristics, and prescription pain medication use in the rheumatoid arthritis population

Background: Chronic pain and high-impact chronic pain (chronic pain that frequently limits life or work activities) are among the most common reasons adults seek medical care and are associated with decreased quality of life, opioid dependence, and poor mental health. Rheumatoid arthritis (RA) is a progressive autoimmune disease characterized by chronic inflammatory arthritis of the joints and associated chronic pain. Characterization of the epidemiology of the RA population in the US informs efforts to develop new therapies for this population and alleviate disease burden.

Objectives: To estimate the most recent prevalence of RA in the United States using the 2017-2020 National Health and Nutrition Examination Survey (NHANES) survey data and to describe changes in the utilization of prescription medications for pain between 2009-2010 to 2017-2020.

Methods: NHANES, a nationally representative, cross-sectional, biannual survey conducted by the National Center for Health Statistics was used to estimate RA prevalence per 100 and associated 95% confidence intervals (CI). There were 574 (unweighted data) participants ≥20 years self-reporting RA in 2017-2020. Select demographics, comorbidities, and clinical conditions were compared between participants with RA versus a reference population without arthritis using standardized mean differences (smd). The proportion of participants with RA self-reporting use of prescription pain medications in the past 30 days was compared between 2009-2010 and 2017-2020.

Results: The prevalence of RA was 4.4 per 100 (95% CI: 3.7,5.2) representing 10,597,621 individuals and increased across age groups; prevalence for 20-39, 40-64, and ≥65 years, 1.4 (95% CI: 0.8,2.2), 5.8 (95% CI: 4.8,7.0), and 6.8 (95% CI: 5.3,8.5), respectively. Patients with RA were older (mean age 57 vs 43 years; smd=-0.24), had a higher proportion of non-Hispanic Black individuals (17.3% vs 11.8%; smd=0.29), obesity (44.5% vs 38.3%, smd=0.16), diabetes (22.5% vs 8.4%, smd=0.40), myocardial infarction (8.3% vs 2.1%, smd=0.29) and moderate and severe depression (17.2% vs 6.1%; smd=0.42) than those without arthritis. The use of gabapentinoids (17.1% vs 25.2%) and skeletal muscle relaxants (11.1% vs 13.8%) in the RA population increased from 2009-2010 to 2017-2020; use of opioids (36.3% vs 16.8%) and NSAIDs (39.8% vs 28.3%) decreased.

Conclusions: The prevalence of RA reported in this study was consistent with previous cycles of NHANES data (2005-2018). Those with RA have more co-morbidities than those without arthritis. Changes over time in the use of prescription medications to manage pain may reflect a shift away from opioids and NSAIDs toward alternative therapeutic approaches.