Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Proton pump inhibitor use may raise women’s risk for rheumatoid arthritis

Publish date:: July 17, 2020

Key clinical point: Regular use of proton pump inhibitors (PPI) was associated with significantly increased risk of rheumatoid arthritis in women; higher risk was associated with longer duration of use.

Major finding: Women who regularly used proton pump inhibitors had a 44% increased risk of RA (HR = 1.44; 95% CI, 1.10- 1.89), compared with non-regular users, after adjustment for potential confounders and lagging PPI use for 2 years.

Study details: The data come from a prospective study of 421 cases of RA over 1,753,879 person-years of follow-up among participants in the Nurses’ Health Study.

Disclosures: The study was supported by grants from the Startup Fund for the 100 Top Talents Program at Sun Yat-sen University, the National Institutes of Health, and the Fundamental Research Funds for the Central Universities. One author reported personal fees from Bristol-Myers Squibb, Gilead, Inova, Janssen, and Optum.

Commentary

“The nature of the role of the gut microbiome in the development of RA is of great interest in terms of understanding the overall etiology of RA; antibiotic exposure, which may alter gut flora, has been shown to be a risk factor for RA. PPI use may also alter gut flora; this study, using the Nurse’s Health Study (NHS) and NHS II cohorts, used the routine biennial questionnaires to pose the question of PPI exposure and calculate incident RA (among respondents without a prior reported diagnosis of RA or SLE). PPI use was associated with a higher risk of RA compared to non-PPI use; this effect was not seen with H2 receptor blockers. Risk of RA also decreased with time after cessation of PPI use. This association is interesting as it may be that gastric acid content plays a role in RA pathogenesis; however, because the study is observational, causation cannot be proven, and the RA risk may be due to another factor also associated with PPI use. However, given the persistent effect noted, further investigation of the potential relationship between gastric acid and RA pathogenesis seems warranted.”