慢性疼痛在风湿性关节炎（RA）患者中很普遍，增加了使用阿片类药物的风险。本研究的目的是评估疾病修复性抗风湿药物（DMARD）的使用情况及其对RA患者长期使用阿片类药物的影响。这项队列研究包括2017年接受至少连续30天阿片类药物处方且诊断为RA的医保受益人（n=23,608）。患者被分为非DMARD用户和DMARD用户，后者进一步被分成美国风湿病学会制定的方案。 结果是2018年长期使用阿片类药物，定义为连续接受至少90天的阿片类药物处方。还评估了阿片类药物使用的剂量和持续时间。还进行了识别与非DMARD使用相关因素的多变量模型。与非DMARD用户相比，DMARD用户长期使用阿片类药物的几率显著降低（比值比为0.89；95％置信区间为0.83-0.95）。除非非肿瘤坏死因子生物制剂+甲氨蝶呤外的所有方案都与非DMARD用户相比降低了长期使用阿片类药物的几率。相比非DMARD用户，DMARD用户的平均总吗啡毫克当量、每日吗啡毫克当量和使用阿片类药物的总天数更低。年龄较大、男性、黑人种族、精神和医疗共病和未见风湿病专科医生与非DMARD使用有显著关联。疾病修复性抗风湿药物的使用与RA患者基线阿片类药物处方的长期使用几率降低有关。与非DMARD使用有关的因素为干预提高RA患者与疼痛相关的生活质量提供了机会窗口。版权所有©2023 Wolters Kluwer Health，Inc.。保留所有权利。

The prevalence of chronic pain is high in patients with rheumatoid arthritis (RA), increasing the risk for opioid use. The objective of this study was to assess disease-modifying antirheumatic drug (DMARD) use and its effect on long-term opioid use in patients with RA.This cohort study included Medicare beneficiaries with diagnosis of RA who received at least 30-day consecutive prescription of opioids in 2017 (n = 23,608). The patients were grouped into non-DMARD and DMARD users, who were further subdivided into regimens set forth by the American College of Rheumatology. The outcome measured was long-term opioid use in 2018 defined as at least 90-day consecutive prescription of opioids. Dose and duration of opioid use were also assessed. A multivariable model identifying factors associated with non-DMARD use was also performed.Compared with non-DMARD users, the odds of long-term opioid use were significantly lower among DMARD users (odds ratio, 0.89; 95% confidence interval, 0.83-0.95). All regimens except non-tumor necrosis factor biologic + methotrexate were associated with lower odds of long-term opioid use relative to non-DMARD users. The mean total morphine milligram equivalent, morphine milligram equivalent per day, and total days of opioid use were lower among DMARD users compared with non-DMARD users. Older age, male sex, Black race, psychiatric and medical comorbidities, and not being seen by a rheumatologist were significantly associated with non-DMARD use.Disease-modifying antirheumatic drug use was associated with lower odds of long-term opioid use among RA patients with baseline opioid prescription. Factors associated with non-DMARD use represent a window of opportunity for intervention to improve pain-related quality of life in patients living with RA.Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.