P148 Gastrointestinal symptoms and proton pump inhibitor use in patients with polymyalgia rheumatica: results from the PMR Cohort study

Abstract

Abstract Background Polymyalgia Rheumatica (PMR) is a common disorder of older adults, characterised by pain and stiffness in the shoulders and hips. PMR is one of the commonest indications for long-term glucocorticoid use. Because of the well-recognised side effects of glucocorticoids including gastrointestinal disturbances and bleeding, guidelines recommend consideration of gastrointestinal prophylaxis. The aim of this study was to assess the proportion of PMR patients who report 1) gastrointestinal disturbances; and 2) appropriate prophylactic treatment, and to investigate other factors that may be associated with the development of gastrointestinal disturbances. Methods 652 people diagnosed in primary care with incident PMR were recruited. Participants all responded to a baseline postal survey and were followed up postally at 1, 4, 8, 12, 18 and 24 months. At each time point, participants answered a range of questions relating sociodemographic, general health and their PMR. At baseline, respondents reported proton pump inhibitors (PPI) use and at 4, 12 and 24 months the presence and extent of any gastrointestinal symptoms (ulcer, wind, indigestion, heartburn; not bothered, bothered a little, bothered a lot). The association of gastrointestinal symptoms with age, gender and PPI use was quantified using proportional odds regression. Results Overall, 51% of people reported PPI use at baseline. Reporting of gastrointestinal symptoms was commoner at all time points in people prescribed a PPI at baseline (Table 1). There was no association between age and bothersomeness of gastrointestinal symptoms (odds ratio 0.98 (0.96, 1.00)), but more bothersome symptoms were more likely in females (2.44 (1.72, 3.45)). PPI use at baseline was significantly associated with a high level of bothersomeness compared to no/little bother (2.45 (13.39, 4.36)), but not with being bothered compared to not being bothered (1.23 (0.87, 1.74)). Conclusion Around half of patients with PMR report gastrointestinal symptoms. Symptoms are more prevalent in females and those prescribed a PPI. This suggests that GPs are prescribing PPIs in those they consider at higher risk of experiencing gastrointestinal symptoms. However, almost half of those without a PPI reported such symptoms within 4 months. Clinicians should be more aware of the potential for gastrointestinal symptoms in PMR. Disclosures H. Feddah None. S. Muller None. S. Hider None. C. Hay None. C. Mallen None.