Increased Incidence and Impact of Upper and Lower Gastrointestinal Events in Patients with Rheumatoid Arthritis in Olmsted County, Minnesota: A Longitudinal Population-based Study

Abstract

Objective To assess the incidence and mortality impact of upper and lower gastrointestinal (GI) events in rheumatoid arthritis (RA) compared to non-RA subjects. Methods We identified incident upper and lower GI events and estimated their incidence rates using person-year methods in a population-based incident RA cohort of residents of Olmsted County, Minnesota, USA (1987 American College of Rheumatology criteria first fulfilled between January 1, 1980, and January 1, 2008) and non-RA subjects from the same population. Results The study included 813 patients with RA and 813 non-RA subjects (mean followup 10.3 and 10.8 yrs, respectively); 68% women; mean age 55.9 yrs in both cohorts. The rate of upper GI events/100 person-years was 2.9 in RA versus 1.7 in the non-RA cohort (rate ratio 1.7, 95% CI 1.4, 2.2); for lower GI events, the rates were 2.1 in RA versus 1.4 in the non-RA cohort (rate ratio 1.5, 95% CI 1.1, 1.9). The incidence of upper GI bleed, perforation, ulcer, obstruction, and any upper GI event in RA declined over calendar time; the incidence of lower GI events remained unchanged. Exposure to glucocorticoids, prior upper GI disease, abdominal surgery, and smoking were associated with lower GI events in RA. Both upper and lower GI events were associated with increased mortality risk in RA. Conclusion There is increased risk of serious upper and lower GI events in RA compared to non-RA subjects, and increased GI-related mortality in RA. Prominent declines in incidence of upper, but not lower GI events in RA highlight the need for studies investigating lower GI disease in patients with RA.

Breath Methane Levels Are Increased Among Patients with Diverticulosis

“…Among subjects with diverticulosis, we also noted a higher prevalence of rheumatologic diseases. The latter association is in line with earlier studies [10] that found associations between inflammatory connective tissue disorders and diverticulosis. Similarly, subjects with diverticulosis were more likely to have hypertension and use anti-hypertensive medications compared to those without diverticulosis.…”

Brief Report: Risk of Gastrointestinal Perforation Among Rheumatoid Arthritis Patients Receiving Tofacitinib, Tocilizumab, or Other Biologic Treatments

“…In a study of RA patients receiving biologic treatment (primarily TNFi) (3), those taking systemic glucocorticoids had a higher rate of GI perforation (1.12 per 1,000 patientyears) than those not taking systemic glucocorticoids (0.47 per 1,000 patient-years). In a separate study using a different database, findings were similar, and the overall GI perforation rate was 0.87 per 1,000 patient-years (12). These results are consistent with the rate of GI perforations observed in the certolizumab pegol trial program, i.e., 0.7 per 1,000 patient-years, based on 6 cases (13).…”

Influence of methotrexate on gastrointestinal symptoms in patients with rheumatoid arthritis

“…Gastrointestinal symptoms are some of the most common comorbidities that can adversely affect quality of life (QoL) in patients with RA . Relative to their healthy counterparts, patients with RA face an increased risk of upper and lower GI events, as well as increased GI‐related mortality . Non‐steroidal anti‐inflammatory drugs (NSAIDs) and glucocorticoids are known risk factors for GI symptoms, while acid‐suppressive drugs such as proton pump inhibitors reportedly decrease NSAID‐related GI symptoms .…”