Association of Spondyloarthritis With Chronic Opioid Use in Inflammatory Bowel Disease: A Nationwide Danish Cohort Study

IMPORTANCE AND OBJECTIVE: Chronic opioid use may increase the risk of complications in patients with inflammatory bowel disease (IBD). Rheumatologic illness has been identified as a risk factor for chronic opioid use in IBD, but the specific influence of spondyloarthritis (SpA) on this risk is unclear.

DESIGN, SETTING, AND PARTICIPANTS: This nationwide cohort study included adults diagnosed with Crohn's disease (CD) or ulcerative colitis (UC) between 1999 and 2021 in Denmark.

EXPOSURES: We compared IBD patients with SpA diagnosed within 3 years before or after the IBD diagnosis (ie IBD+SpA) and IBD patients without SpA.

MAIN OUTCOMES AND MEASURES: The primary outcome was chronic opioid use ≤3 years after IBD diagnosis, defined as ≥3 opioid prescriptions ≥1 month apart within a 12-month period. Using multivariable logistic regression, we determined the association of SpA with chronic opioid use while adjusting for age, sex, IBD type, year of IBD diagnosis, Charlson comorbidity index, and psychotropic medications.

RESULTS: We identified 45 172 patients diagnosed with IBD between 1999 and 2021, among which 666 had IBD+SpA. Chronic opioid use occurred in 20.4% of IBD+SpA versus 9.8% of IBD-only patients. SpA was associated with increased odds of chronic opioid use (adjusted odds ratio 2.78, 95% confidence interval, 2.26-3.42). Similar associations were seen across IBD+axial or peripheral SpA, UC+SpA, and CD+SpA subgroups as well as a sub-analysis of chronic use of only strong opioids.

CONCLUSIONS AND RELEVANCE: In this nationwide cohort, SpA was strongly associated with chronic opioid use in patients diagnosed with IBD. These findings highlight IBD+SpA as a high-risk phenotype warranting early identification and multidisciplinary pain management.