Background
Rheumatoid arthritis (RA) affects ~19 million adults globally and is commonly managed with a combination of disease-modifying antirheumatic drugs (DMARDs) and pain medicines. Where the response to DMARDs has been good, deprescribing of pain medicines may be appropriate.
Aim
To evaluate the evidence on the benefits and harms of common analgesics used in people with RA to guide patient and clinician decision making around deprescribing.
Methods
We performed a narrative synthesis of the efficacy and harms of analgesics including opioids, non-steroidal anti-inflammatory drugs (NSAIDs), muscle relaxants and anticonvulsants for RA. We also explored the attitudes and acceptability of deprescribing pain medicines in people with RA and propose a communication strategy that can support informed decision-making, particularly as one in seven adults with RA have low health literacy.
Results
Five systematic reviews (n= 30 trials; 9393 participants) evaluated the efficacy and harms of analgesics such as opioids, non-steroidal anti-inflammatory drugs (NSAIDs), muscle relaxants and anticonvulsants. Across reviews, there is conflicting evidence around the benefits of analgesics for the management for RA, and was associated with adverse events such as nausea, vomiting and dizziness.
Guidelines around deprescribing analgesics for RA are limited, and patient attitudes around deprescribing are limited to DMARDS (n=2 trials). Patients report a willingness to deprescribe medicines if benefits outweighed the risks and may also be associated with their level of health literacy.
Conclusion
Deprescribing of pain medicines for RA may include a shared decision model between the clinician and patient, and should include re-evaluation of all medicines, including DMARDS monitoring of patient symptoms, and patient preference for management.