Objective To investigate the association between proton pump inhibitor (PPI) use and the presence and severity of calcinosis in SSc. Methods We analysed data from two SSc cohorts from a single centre. Cohort 1 included 199 patients reviewed over 10 years, for whom retrospective data on PPI use and calcinosis were available. Cohort 2 was recruited prospectively and included 215 consecutive patients, who underwent clinical assessment. Outcomes of interest were presence of current calcinosis (CC) or calcinosis at any time (CAT). Results The cohort 1 data analysis showed that among patients on standard dose PPI 20% had calcinosis, while in those on high doses of PPI calcinosis was present in 39% (P = 0.003). Analysis of the data from cohort 2 confirmed these findings, demonstrating that the odds of CAT increased significantly with longer PPI exposure [odds ratio (OR) 1.04, 95% CI: 1.02, 1.06; P < 0.001], longer disease duration (OR 1.08, 95% CI: 1.05, 1.12; P < 0.001) and greater age (OR 1.03, CI: 1.01, 1.05; P = 0.010). Multivariable logistic regression showed that higher exposure to PPI remained a significant predictor of calcinosis, with PPI exposure >10 years increasing the risk of CAT >6-fold, compared with no PPI (OR 6.37, 95% CI: 1.92, 21.17; P = 0.003) after adjusting for disease duration and antibodies. Conclusion We confirm a significant association between high PPI exposure with severity of calcinosis in SSc. Given the clinical impact of calcinosis and reflux in SSc, PPI exposure as a potentially modifiable risk factor for calcinosis requires further evaluation.

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IntroductionInflammatory status could play a role in alterations of blood pressure (BP) circadian rhythm. The aim of our study is to compare levels of usual inflammatory markers in patients with and without circadian BP abnormalities.Material and methodsThis is a cross-sectional design study with retrospective data analysis which included patients from an Internal Medicine Department with normal and high BP levels older than 18 years who were separated into two groups according to the circadian profile of BP (dipper and non-dipper) based on the results of 24-hour ambulatory BP monitoring. Patients were assessed for demographic characteristics and cardiovascular risk factors. We considered as inflammatory markers the platelet count (PTC), erythrocyte sedimentation rate (ESR), ultra-sensitive C-reactive protein, ferritin, fibrinogen, and uric acid.ResultsThe study included 551 patients (mean age of 54 years, 47% women). The non-dipper group had a higher percentage of individuals with higher ESR (OR = 1.77, 95% CI: 1.23–1.55, p = 0.001), uric acid (OR = 1.50, 95% CI: 1.04–2.16, p = 0.028) and fibrinogen (OR = 1.72, 95% CI: 1.18–2.51, p = 0.001) and a higher percentage of patients with higher PTC (OR = 0.54, 95% CI: 0.37–0.78, p = 0.005). These results were independent of age, waist circumference, presence of arterial hypertension, diabetes or hyperlipidemia, and use of antihypertensive drugs including renin angiotensin aldosterone system blockers.ConclusionsPatients with impaired circadian BP rhythm were associated with an unfavorable inflammatory status independently of BP levels. This fact could play a role in the prognostic differences observed between dipper and non-dipper patients.