Description
Introduction: Arthritis remains a leading cause of chronic pain, disability, and healthcare expenditure in the United States, affecting over 53-million adults and contributing to economic burden exceeding $580 billion/annum. Despite widespread use, evidence on the impact of chronic opioid therapy on functional outcomes and healthcare utilization is limited. This study evaluates impact of opioid use on functional status and healthcare utilization among arthritis patients using methotrexate. Methods: A retrospective cohort study was conducted using 2018 - 2022 data from the Medical Expenditure Panel Survey. Adults (18 years) with arthritis using methotrexate were categorized into opioid users and non-opioid users. Functional outcomes include walking limitation, social limitation, pain limitation, and mental health status. Healthcare utilization was measured using total and subcategory expenditures, including inpatient, emergency, office-based, and prescription costs. Survey-weighted logistic regression models estimated adjusted odds ratios (ORs) for functional outcomes, while survey-weighted linear regression of log-transformed expenditures estimated cost ratios (CRs). Models adjusted for demographic, socioeconomic, and clinical factors. Results: A total of 7978 arthritis patients were identified, with 36.3% receiving opioids. Opioid users exhibited significantly worse functional outcomes, with higher odds of walking limitation (OR 1.98, 95% CI:1.76‚ 2.22), social limitation (OR 1.78, 95% CI:1.56‚2.03), and pain limitation (OR 2.32, 95% CI:1.98‚ 2.71), while mental health differences were not statistically significant. Opioid use was also associated with substantially higher healthcare expenditures, including total costs (CR 1.68, 95% CI:1.57‚ 1.80), inpatient costs (CR 3.15, 95% CI:2.59‚ 3.83), emergency room costs (CR 1.88, 95% CI:1.60‚ 2.22), and prescription costs (CR 1.34, 95% CI:1.22‚ 1.47). These patterns remained consistent across all study years, indicating persistent functional impairment and increased healthcare utilization among opioid users. Conclusion: Opioid use among arthritis patients receiving methotrexate is associated with worse functional outcomes and significantly higher healthcare utilization, suggesting that opioids may not provide long-term functional benefit in this population. These findings support policy efforts to reduce chronic opioid prescribing in arthritis care and promote alternative, evidence-based pain management strategies, including optimization of multimodal approaches. Incorporating these insights into value-based care models and clinical guidelines may improve patient outcomes while reducing healthcare costs at the population level.
Publication Info
2026.