Skip to main content

Thank you for visiting You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

PAIN IN 2019

Towards defining the safer use of opioids in rheumatology

Use of prescription opioids is prevalent in patients with rheumatic diseases. Studies in 2019 reported the trends and safety of opioids in patients with rheumatoid arthritis or osteoarthritis. Treating underlying disease processes must be the rheumatologists’ priority. Without better long-term safety and effectiveness data, opioid use should be generally limited.

Key advances

  • Chronic use of opioids in patients with rheumatoid arthritis in the USA doubled from 7.4% in 2002 to 16.9% in 2015 despite availability of a growing number of DMARDs2.

  • Implementation of a guideline-based opioid safety initiative led to a decrease in rates of opioid prescribing for osteoarthritis without changes in patient-reported pain intensity3.

  • Use of tramadol is associated with greater mortality compared with NSAIDs among older patients with osteoarthritis4.

This is a preview of subscription content, access via your institution

Relevant articles

Open Access articles citing this article.

Access options

Rent or buy this article

Get just this article for as long as you need it


Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Trends and safety in opioid use in 2019.


  1. Busse, J. W. et al. Opioids for chronic noncancer pain: a systematic review and meta-analysis. JAMA 320, 2448–2460 (2018).

    Article  Google Scholar 

  2. Lee, Y. C. et al. Chronic opioid use in rheumatoid arthritis: prevalence and predictors. Arthritis Rheumatol. 71, 670–677 (2019).

    Article  CAS  Google Scholar 

  3. Trentalange, M. et al. Analgesic prescribing trends in a national sample of older veterans with osteoarthritis: 2012–2017. Pain 160, 1319–1326 (2019).

    Article  Google Scholar 

  4. Zeng, C. et al. Association of tramadol with all-cause mortality among patients with osteoarthritis. JAMA 321, 969–982 (2019).

    Article  CAS  Google Scholar 

  5. Kim, S. C. et al. Association of preoperative opioid use with mortality and short-term safety outcomes after total knee replacement. JAMA Netw. Open 2, e198061 (2019).

    Article  Google Scholar 

  6. Hochberg, M. C. et al. American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. Arthritis Care Res. 64, 465–474 (2012).

    Article  CAS  Google Scholar 

  7. Jevsevar, D. S. et al. The American Academy of Orthopaedic Surgeons evidence-based guideline on: treatment of osteoarthritis of the knee, 2nd edition. J. Bone Joint Surg. (Am.) 95, 1885–1886 (2013).

    Article  Google Scholar 

  8. Bannuru, R. R. et al. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis Cartilage 27, 1578–1589 (2019).

    Article  CAS  Google Scholar 

  9. Fournier, J. P. et al. Tramadol use and the risk of hospitalization for hypoglycemia in patients with noncancer pain. JAMA Intern. Med. 175, 186–193 (2015).

    Article  Google Scholar 

  10. Vestergaard, P., Rejnmark, L. & Mosekilde, L. Fracture risk associated with the use of morphine and opiates. J. Intern. Med. 260, 76–87 (2006).

    Article  CAS  Google Scholar 

Download references


S.C.K. is supported by NIH grants R01AR069557 and R01AR073314. D.H.S. is supported by NIH grants U01AR068043 and R01HL119718.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Seoyoung C. Kim.

Ethics declarations

Competing interests

The authors declare no completing interests.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Kim, S.C., Solomon, D.H. Towards defining the safer use of opioids in rheumatology. Nat Rev Rheumatol 16, 71–72 (2020).

Download citation

  • Published:

  • Issue Date:

  • DOI:

This article is cited by


Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing