Alert! This type of commonly used gastric drug increases the risk of wind-like closure by 44%. A week of wind and clouds.

A week of wind and cloud, waiting for you to see! PPI is also a common "stomach protecting" drug for rheumatic patients. Proton pump inhibitors (PPI) act on H + - K + - ATPase, which can inhibit gastric acid secretion caused by basic and various reasons.these drugs have the advantages of rapid onset, strong and lasting acid inhibition, good safety and tolerance, and are the first choice of drugs for clinical treatment and prevention of acid related diseases.common PPIs include omeprazole, lansoprazole, pantoprazole, rabeprazole, esomeprazole, and eprazole.its indications include the treatment of gastric ulcer, gastroesophageal reflux disease, Helicobacter pylori infection and prevention of drug-induced gastric mucosal injury.drugs that are easy to cause gastric mucosal damage, such as glucocorticoids, NSAIDs, anticoagulants, antiplatelet drugs, etc.among them, glucocorticoids and NSAIDs are commonly used drugs in the Department of Rheumatology and immunology, and PPI is often used in the prescriptions of many rheumatic patients.RA risk increased by 44%, women should pay attention! However, a recent study published in the journal alimentary Pharmacology & Therapeutics showed that regular use of PPI increased the risk of rheumatoid arthritis (RA) in women.421 female RA patients were included in the study, and the follow-up time was more than 1753879 person years.the results showed that the RA risk was 44% (HR = 1.44; 95% CI 1.10-1.89) higher in the PPI regular users than in the non conventional PPI users.RA risk increased with the total duration of PPI use (P =. 008).compared with unconventional users, women who used for 4 years or less (HR = 1.22; 95% CI, 0.93-1.62) and women who used more than 4 years (AHR = 1.73; 95% CI, 1.14-2.61) had a higher risk of RA.Table 1 risk of RA caused by regular use of PPI Table 2 Compared with the participants who did not use PPI, people who used PPI often had lower exercise load, higher BMI and higher incidence of hypertension, hypercholesterolemia, diabetes, gastric or duodenal ulcer and gastroesophageal reflux disease, and were more likely to use NSAIDs and glucocorticoids BMI and exercise) are known risk factors for RA.the mechanism of the association between PPI use and RA is unclear, which may be mediated by intestinal flora.there is sufficient evidence that proton pump inhibitors may lead to intestinal ecological disorders, which may participate in the immune development mechanism of RA.some bacteria, such as Escherichia coli, may also participate in the disease process of RA.in addition, PPI may block the function of transforming growth factor beta (TGF - β) through alkalization of pH, thus increasing the risk of RA.enhancement of GF - β function is one of the key methods to restore the stability of RA joint.how to use "stomach protecting medicine" for rheumatic patients? ▎ NSAIDs and PPI "expert consensus on optimal application of proton pump inhibitors" (hereinafter referred to as "consensus") have classified the risk of gastric mucosal damage caused by NSAIDs, with a total of 6 grades.Table 3: risk classification of gastrointestinal side effects in patients taking NSAIDs. It is pointed out that NSAIDs should be avoided in patients with high risk of gastrointestinal injury caused by NSAIDs.if necessary, cyclooxygenase-2 (COX-2) inhibitors (celecoxib, etc.) can be selected and combined with PPIs.moderate risk patients can choose selective COX-2 inhibitors or traditional non selective NSAIDs (diclofenac sodium, etc.) combined with PPIs.low risk patients without risk factors do not need PPIs prophylactically.▎ glucocorticoids and PPI glucocorticoids have anti-inflammatory, anti immune, anti rheumatic and anti shock effects.at the same time, glucocorticoid is also easy to cause adverse reactions of gastric ulcer and bleeding.PPIs on the preventive use of glucocorticoids in the expert consensus on the preventive application of proton pump inhibitors (2018) is described as follows: Figure 1: screenshot of expert consensus on preventive application of proton pump inhibitors (2018). As is originally a disease more common in men, and CKD is a common complication of as patients.in conclusion, compared with female patients, male as patients are more likely to have CKD progression or severe condition.among them, hyperuricemia is a strong independent risk factor for CKD in men and women, but y1s1, the risk of hyperuricemia in premenopausal women is relatively small, therefore, male patients with as must pay attention to the control of uric acid! Reference source: [1] Shan Qing, sun an Xiu. Expert consensus on preventive application of proton pump inhibitors (2018) [J]. Chinese Journal of physicians, 2018, 20 (12): 24-30. [3] Chinese Pharmaceutical Association. Expert consensus on optimal application of proton pump inhibitors [J]. Chinese Journal of hospital pharmacy. May 2020