Peptic ulcer in rheumatoid arthritis.

Abstract

GlasgowSUMMARY In a study of patients attending a rheumatology clinic 230 unselected patients, 185 with rheumatoid arthritis (RA) and 45 with other rheumatic disorders (non-RA), were examined by endoscopy and a detailed history of symptoms referable to the gastrointestinal tract was taken. A peptic ulcer was found in 67 (36%) of the patients and in 13 (29%) of the non-RA group. Gastric ulceration was more common in the group with RA (32 patients (17%) compared with three patients (7%) in the non-RA group); 17/32 (53%) patients with RA and gastric ulcer were asymptomatic. In the group with RA, of those with gastric ulcer 20/32 (63%) were smokers, compared with only 40/118 (34%) of the non-ulcer group. There was no difference in the duration of rheumatic disease or non-steroidal anti-inflammatory drug (NSAID) treatment between the ulcer and non-ulcer groups. Treatment with H2 receptor antagonist and maintenance of NSAID treatment resulted in healing in 26 out of 29 (90%) patients with gastric ulcer and 23 out of 27 (85%) patients with duodenal ulcer.Key words: non-steroidal anti-inflammatory drugs, H2 antagonists, arthritis.There has been much recent interest in the association between peptic ulceration, non-steroidal antiinflammatory drugs (NSAIDs), and rheumatoid arthritis (RA).' The Committee on Safety of Medicines has drawn attention to the risks of gastrointestinal haemorrhage in elderly patients receiving NSAIDs,2 3 and several reports have confirmed this association.4 Iron deficiency anaemia is a common feature of RA and is often caused by an asymptomatic peptic ulcer. The aetiology of peptic ulceration in RA is controversial, and it is not clear whether the apparent increase in peptic ulceration in this condition is due to the disease itself or to the drugs commonly used in treatment. We have, therefore, studied the prevalence of peptic ulceration in our patients with RA attending a rheumatology clinic, and compared them with subjects with other rheumatic diseases.

Nonsteroidal Anti-Inflammatory Drug-Induced Gastric Damage: Epidemiology

“…The suggestion that patients with rheumatoid arthritis are more prone to gastric ulceration has been much dis cussed but it is not supported by clinical evi dence. Some studies in rheumatoid arthritis patients have found an excess of GUs [23][24][25], others have not [28] and some have found a large excess of GUs in the control group of osteoarthritis patients taking NSAIDs [27] -suggesting that the drugs themselves rather than the disease are of pri mary importance.…”

Aspirin‐induced gastric mucosal damage: prevention by enteric‐coating and relation to prostaglandin synthesis.

“…Prospective cohort studies suggest a 50% enhancement (Beard et al, 1987;Carson et al, 1987). Case control studies place the relative risk at between three and five (Armstrong & Blower, 1987;Faulkner et al, 1988& Somerville et al, 1986, whilst uncontrolled endoscopic studies have suggested a much greater risk (Collins & du Toit, 1987;Farah et al, 1988;Larkai et al, 1987).…”

Effect of misoprostol on concentrations of prostaglandins in synovial fluid.

“…Peptic ulceration has been demonstrated by endoscopy in 80 of 230 unselected patients receiving regular NSAID treatment. 5 In one prospective endoscopic study NSAID treatment resulted in a 50% incidence of ulceration and mucosal inflammation.6 Non-steroidal anti-inflammatory drug induced gut lesions lead to significant morbidity through dyspepsia, bleeding and perforation, and can lead to an appreciable rate of death.7 8 Such lesions may often be asymptomatic. 9 If the withdrawal of the NSAID is impractical for a particular patient, the prevention of NSAID induced gut lesions assumes additional importance.…”