Chronic Prescription Opioid Use Before and After Total Hip and Knee Arthroplasty in Patients Younger Than 65 Years.

BACKGROUND: Opioids are commonly prescribed to patients with painful and symptomatic degenerative joint disease preoperatively as a nonoperative intervention to reduce patients' symptoms and pain. The goal of total joint arthroplasty (TJA) is to reduce or eliminate the painful symptoms of degenerative joint disease. Due to the addictive property of opioid medications, some patients may develop a pattern of chronic opioid use after TJA. METHODS: We used MarketScan Commercial Claims and Encounters database to identify 125,019 patients (age <65 years) who underwent total knee arthroplasty (TKA) and total hip arthroplasty (THA) between 2009 and 2012. During the study period, opioid use was analyzed 3 months before surgery and at 12 months after surgery. We defined chronic opioid use as having 2 or more opioid prescriptions filled within any 6-week period. Multivariate logistic regression was used. RESULTS: Of the 24,127 patients who were chronic prescription opioid users before surgery, 72% were no longer chronic users 1 year after surgery. Of the 100,892 patients who were nonusers before surgery, 4% became chronic users within 1 year after surgery. TKA and hospital stay longer than 3 days were significant risk factors of persisting chronic opioid use after surgery, while age played a mixed role in predicting change of opioid use. CONCLUSION: Using our definition of chronic use, overall chronic opioid use decreased from 19% to 9% after TJA. Patients were more likely to cease chronic opioid use after TJA (72%) than to become chronic users (4%).

HIV disease activity as a modulator of lipoprotein(a) and allele-specific apolipoprotein(a) levels.

OBJECTIVE: Mechanisms underlying the cardiovascular risk of lipoprotein(a) are poorly understood. We investigated the relationship of apolipoprotein(a) (apo(a)) size, lipoprotein(a), and allele-specific apo(a) levels with HIV disease activity parameters in a biethnic population. METHODS AND RESULTS: Lipoprotein(a) and allele-specific apo(a) levels were determined in 139 white and 168 black HIV-positive patients. Plasma HIV RNA viral load and CD4+ T-cell count were used as surrogates for disease activity. Lipoprotein(a) and allele-specific apo(a) levels were higher in blacks than whites (for both P<0.001). Apo(a) allele size distribution was similar between the 2 ethnic groups, with a median apo(a) size of 28 kringle 4 repeats. Allele-specific apo(a) levels were positively associated with CD4+ T-cell count (P=0.027) and negatively with plasma HIV RNA viral load (P<0.001). Further, allele-specific apo(a) levels associated with smaller (<28 kringle 4) atherogenic apo(a) sizes were higher in subjects with CD4+ T-cell counts of ≥350 (P=0.002). CONCLUSIONS: Allele-specific apo(a) levels were higher in subjects with high CD4+ T-cell count or low plasma HIV RNA viral load. The findings suggest that HIV disease activity reduced allele-specific apo(a) levels. Higher allele-specific apo(a) levels associated with atherogenic small apo(a) sizes might contribute to increased cardiovascular risk in HIV-positive subjects with improved disease status.