Increased risk of reproductive dysfunction in women prescribed long-term opioids for musculoskeletal pain: A matched cohort study in the Clinical Practice Research Datalink

Abstract Background: Porphyria cutanea tarda (PCT) is a skin disorder caused by a defect in the liver enzyme uroporphyrinogen decarboxylase and is associated with hepatitis C virus infection, high alcohol intake, smoking and iron overload. Data on the long-term morbidity of PCT is lacking. Methods: We conducted a nationwide matched cohort study over a 24-year period. The study sample included 534 persons aged 18-67 years with a biochemically confirmed PCT diagnosis and a sample of 21,360 persons randomly selected from the working age population, matched on age, sex and educational attainment. We investigated if persons with sporadic and familial PCT had an increased risk of long-term sick leave (LTSL) or disability pension. We further assessed risk before (pre-PCT), during (during-PCT) and after (post-PCT) the typical period of first onset to diagnosis, treatment and remission. Results: Overall, persons with PCT had a 40% increased risk (hazard ratio [HR]=1.4, 95% confidence interval [CI]=1.3, 1.5) of LTSL and a 50% increased risk (HR=1.5, CI=1.3, 1.7) of disability pension. Risk of disability pension was increased pre-PCT (HR=1.3, CI: 1.3 (1.0, 1.6), during-PCT (HR: 1.5, CI: 1.0, 2.2) and post-PCT (HR=2.0, CI: 1.5, 2.6). For LTSL, risk was increased pre-PCT (HR=1.3, CI: 1.1, 1.4) and during-PCT (HR=1.5, CI: 1.1, 2.1), but not post-PCT. Risk was greatest in persons with sporadic than familial PCT. Diagnostic reasons for disability pension that were increased compared to matched controls were PCT or skin disease in 11 of 199 cases (PCT: n=7, incident rate ratios [IRR]=49.2, CI=38.8, 62.4; diseases of the skin & subcutaneous tissue, n=4, IRR=4.2, CI=1.6, 11.0). The vast majority of diagnostic reasons for accessing disability pension were related to comorbidities, PCT susceptibility factors and more general health issues such as: malignant neoplasms (n=12, IRR=2.4, CI=1.4, 4.2), substance and alcohol dependence (n=7, IRR=5.0, CI=2.5, 10.1), neurotic and mood – disorders (n=21, IRR=1.7, CI=1.1, 2.6), and diseases of the musculoskeletal system & connective tissue (n=71, IRR=2.5, CI=1.9, 3.2).Conclusions: Persons with PCT have an increased risk of LTSL and disability pension indicating significant morbidity in this patient group. Appropriate long-term follow-up and monitoring for relapses and co-morbid diseases are recommended.

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Long-term effects of bariatric surgery on acute kidney injury: a propensity-matched cohort in the UK Clinical Practice Research Datalink

BMJ Open ◽

10.1136/bmjopen-2017-020371 ◽

2018 ◽

Vol 8 (5) ◽

pp. e020371

Author(s):

Uwe Koppe ◽

Dorothea Nitsch ◽

Kathryn E Mansfield ◽

Rohini Mathur ◽

Krishnan Bhaskaran ◽

...

Keyword(s):

Bariatric Surgery ◽

Acute Kidney Injury ◽

Clinical Practice ◽

Kidney Injury ◽

Practice Research ◽

Clinical Practice Research Datalink ◽

Matched Cohort ◽

Long Term Effects ◽

The Uk

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Risk of adverse events in patients prescribed long‐term opioids: A cohort study in the UK Clinical Practice Research Datalink

European Journal of Pain ◽

10.1002/ejp.1357 ◽

2019 ◽

Vol 23 (5) ◽

pp. 908-922 ◽

Cited By ~ 10

Author(s):

John Bedson ◽

Ying Chen ◽

Julie Ashworth ◽

Richard A. Hayward ◽

Kate M. Dunn ◽

...

Keyword(s):

Cohort Study ◽

Clinical Practice ◽

Adverse Events ◽

Practice Research ◽

Clinical Practice Research Datalink ◽

The Uk

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The Long-Term Impact of Vaginal Surgical Mesh Devices in UK Primary Care: A Cohort Study in the Clinical Practice Research Datalink

Clinical Epidemiology ◽

10.2147/clep.s333775 ◽

2021 ◽

Vol Volume 13 ◽

pp. 1167-1180

Author(s):

Emily McFadden ◽

Sarah Lay-Flurrie ◽

Constantinos Koshiaris ◽

Georgia C Richards ◽

Carl Heneghan

Keyword(s):

Primary Care ◽

Cohort Study ◽

Clinical Practice ◽

Surgical Mesh ◽

Practice Research ◽

Clinical Practice Research Datalink ◽

Long Term Impact

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AB0576 BONE EROSION IN PSORIATIC ARTHRITIS ASSOCIATED WITH PSORIASIS DURATION, SKIN, NAIL AND JOINT DISEASE SEVERITY

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.2796 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 1325.2-1326

Author(s):

M. Chamurlieva ◽

E. Loginova ◽

T. Korotaeva ◽

Y. Korsakova ◽

E. Gubar ◽

...

Keyword(s):

Clinical Practice ◽

Psoriatic Arthritis ◽

Disease Severity ◽

Bone Erosion ◽

Joint Disease ◽

Practice Research ◽

Forest Plot ◽

Clinical Practice Research Datalink ◽

Increased Risk ◽

Nail Disease

Background:Psoriatic arthritis (PsA) is heterogeneous in its clinical presentation and disease course, but many patients (pts) develop a destructive form of arthritis. Psoriasis (PsO) precedes arthritis by an average of 7 years. [1]. Theory of transition from PsO to PsA has been proposed recently [2]. But association between skin disease severity and joint disease are still unclear.Objectives:to evaluate association between bone erosion, PsO duration, skin and nail disease severity in PsA pts based on data from clinical practice (RU-PsART cohort).Methods:737 (M/F=350/387) PsA pts fulfilling the CASPAR criteria were included. Mean age 47.4±12.7 years (yrs), PsA duration 55[17;120] mos., PsO duration 165[74.5;292] mos., mean DAPSA 23.3[14;36.9] mos., HAQ-DI - 0.98 [0.5;1.38], CRP - 7.4 [2.1;18] mg/l. All pts underwent standard clinical examination (tender joins count (TJC)/68, swelling joints count (SJC)/66, CRP (mg/l), DAPSA, dactylitis, enthesitis by LEI + Plantar Facia (PF), HAQ-DI. Mild disease was defined as body surface area (BSA)≤10%, moderate to severe as BSA>10%. The presence/absent of nail PsO was evaluated. X-ray of feet and hand were done in 622 out of 737 pts. The one-factor model of logistic regression was used to identify a group of features that are associated with achievement MDA. M±SD, Me [Q25; Q75], Min-Max, %, t-test, Pierson-χ2, Manna-Whitney tests, ORs with 95% CI were performed. All p<0.05 were considered to indicate statistical significance.Results:PsO precedes of PsA by an average of 9.2 years. BSA≤10% was found in 615 out of 672 pts (91.5%), BSA>10% - in 57 out of 672 pts (8.5%). Nail PsO were seen in 230 out of 737 (31.2%). Bone erosion was found in 237 out of 622 of pts (38.1%). Among these pts nail PsO were seen in 67 out of 237 pts (28.3%). Enthesitis found in 236 out of 737 pts (42.1%), dactylitis – in 197 out 731 pts (27%), axial PsA – in 315 out of 731 pts (43.1%). Bone erosion significantly associated with PsO duration more than 5 yrs., skin and nail PsO severity, high PsA activity by DAPSA, axial manifestation and duration of PsA > 36 mos. (Figure 1).Figure 1Forest plot of factors associated with bone erosion in PsA pts.Conclusion:In our cohort the majority of PsA pts had mild PsO preceded PsA on average of 9.2 yrs. Bone erosion was found in 30% of PsA pts which associated with PsO duration, skin and nail disease severity as well as with PsA activity. Early diagnosis and therapeutic intervention within a “window of opportunity” are very important for improving outcomes and prevent structural damage in PsA.References:[1]Tillett W, et al. Interval between onset of psoriasis and psoriatic arthritis comparing the UK Clinical Practice Research Datalink with a hospital-based cohort. Rheumatol. 2017; 56, 2109–2113[2]Scher JU, et al. Preventing psoriatic arthritis: focusing on patients with psoriasis at increased risk of transition. Nat Rev Rheumatol. 2019;15(3):153-166. doi: 10.1038/s41584-019-0175-0. PMID: 30742092.Disclosure of Interests:None declared.

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