Steen K S S, Nurmohamed M T, Visman I, Heijerman M, Boers M, Dijkmans B A C, Lems W F
Department of Rheumatology, VU University Medical Center, Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
Ann Rheum Dis. 2008 Feb;67(2):256-9. doi: 10.1136/ard.2006.068015. Epub 2007 Jun 29.
Non-steroidal anti-inflammatory drugs (NSAIDs) frequently cause gastrointestinal (GI) ulcers and complications of ulcers. In 1997 in Amsterdam, the incidence of symptomatic GI events was 2.1% (95% CI 1.0-3.1) in patients with rheumatoid arthritis (RA). We conducted a new prospective, observational study on the symptomatic GI events in our outpatient clinics, and compared the data to a previous study conducted by our group. Over the same time period, a decline of GI events over the last decade was reported for US patients.
In 2003, three questionnaires were sent to all RA patients in Amsterdam at 4-month intervals, addressing medication use, dyspepsia, and symptomatic GI events in the previous 4 months.
The incidence of GI events in high-risk patients, defined as age >or=60 and/or history of GI event) using NSAIDs or cyclo-oxygenase 2 specific inhibitors (COXIBs) was 1.2% (95% CI 0.2-2.3), which appears to be substantially lower than the 2.1% observed in 1997; however this difference did not reach statistical significance (p = 0.3). In 64% (95% CI 61-68) of the high-risk patients, acid-suppressive drugs (ie, proton pump inhibitors, prostaglandin analogues or high dose H2 antagonists) were used. In 1997 this percentage was significantly lower at 49% (45-52; p<0.001). The compliance to the Dutch guidelines for prevention of NSAID-related gastropathy was almost 75%, with 64% of the patients using acid-suppressive drugs and 11% using COXIBs.
The present study reveals a decline of NSAID-induced gastrointestinal events, which is similar to the results observed in the US. This is most likely due to a more strict adherence to guidelines for prevention of NSAID gastropathy, and better treatment of rheumatoid arthritis.
非甾体抗炎药（NSAIDs）常导致胃肠道（GI）溃疡及溃疡并发症。1997年在阿姆斯特丹，类风湿关节炎（RA）患者中出现症状的胃肠道事件发生率为2.1%（95%可信区间1.0 - 3.1）。我们在门诊针对出现症状的胃肠道事件开展了一项新的前瞻性观察性研究，并将数据与我们团队之前进行的一项研究作比较。在同一时期，有报道称美国患者在过去十年中胃肠道事件有所减少。
2003年，每隔4个月向阿姆斯特丹所有类风湿关节炎患者发送三份问卷，询问用药情况、消化不良以及前4个月内出现症状的胃肠道事件。
使用非甾体抗炎药或环氧化酶2特异性抑制剂（COXIBs）的高危患者（定义为年龄≥60岁和/或有胃肠道事件病史）中，胃肠道事件发生率为1.2%（95%可信区间0.2 - 2.3），这似乎显著低于1997年观察到的2.1%；然而，这一差异未达到统计学显著性（p = 0.3）。64%（95%可信区间61 - 68）的高危患者使用了抑酸药物（即质子泵抑制剂、前列腺素类似物或高剂量H2拮抗剂）。1997年这一比例显著较低，为49%（45 - 52；p<0.001）。对荷兰预防非甾体抗炎药相关性胃病指南的依从性近75%，64%的患者使用抑酸药物，11%的患者使用COXIBs。
本研究显示非甾体抗炎药引起的胃肠道事件有所减少，这与美国观察到的结果相似。这很可能是由于更严格地遵守预防非甾体抗炎药胃病的指南以及对类风湿关节炎的更好治疗。
