Chronic Opioid Use Elevated in Gout Patients, Especially in Underserved Groups
A large national study conducted within the U.S. Veterans Health Administration (VA), published in Arthritis and Care Research, has found that patients with gout face a significantly higher risk of chronic opioid exposure compared to individuals without gout, raising concerns about long-term pain management strategies in this growing population.
“Though used frequently to treat flare, risk of chronic opioid exposure in gout has not been well defined,” the authors noted. “In this study, we examined the hypothesis that people with gout are more likely than individuals without gout to be prescribed chronic opioids over time.”
The matched cohort study drew on comprehensive VA data to compare gout patients to up to 10 non-gout controls matched by age, sex, and enrollment year. Gout cases were identified via diagnostic codes, and chronic opioid receipt was assessed using a validated administrative algorithm. Multivariable Cox regression was applied to evaluate the association between gout and chronic opioid use, with additional analyses performed to identify predictors of opioid exposure within the gout cohort.
Over an average follow-up of 4.52 years, 6.9% of patients with gout received chronic opioid prescriptions, compared to 3.8% of matched controls. After adjusting for demographic and clinical factors, gout remained independently associated with a higher likelihood of chronic opioid use (adjusted hazard ratio [aHR] 1.30; 95% CI, 1.28–1.32). Within the gout group, several demographic and clinical characteristics were found to increase the odds of chronic opioid use significantly. These included younger age, female sex, non-Hispanic Black race/ethnicity, rural residence, being underweight or obese, former/current smoking, greater comorbidity, urate-lowering therapy receipt, and requirement of rheumatology consultation.
“Patients with gout are more likely to receive chronic opioids than non-gout counterparts, independent of other factors,” the authors concluded. “This risk is greater in underrepresented gout populations, those with greater comorbidity, patients requiring rheumatology consultations and individuals prescribed urate-lowering treatments.”
Reference
Helget LN, England BR, Roul P, Sayles H, Neogi T, O'Dell JR, Baker JF, Mikuls TR. Chronic opioids in gout: A matched cohort study from the veteran's health administration. Arthritis Care Res (Hoboken). 2025 Aug 4. doi: 10.1002/acr.25622. Epub ahead of print. PMID: 40757470.
