RA Linked to Lower Gut Problems

Rheumatoid arthritis associated to lower gastrointestinal complications

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) People with rheumatoid arthritis are at risk for a number of complications, such as heart disease and lung disease. Now, it appears these arthritis patients have to watch out for gut problems too.

Rheumatoid arthritis patients may have an increased risk of lower gastrointestinal problems, including ulcers and bleeding, compared to people without the disease.

They also have a greater risk of death caused by their gastrointestinal problems.

"Call your doctor with any stomach issues."

For a recent study, Eric Matteson, MD, of the Mayo Clinic, and colleagues wanted to find out the rate of gastrointestinal problems in people with rheumatoid arthritis.

Their results show that lower gastrointestinal problems were more common in rheumatoid arthritis patients than in people without the condition.

More specifically, there were 2.1 cases of lower gastrointestinal problems per 100 person years among people with rheumatoid arthritis. In contrast, there were 1.4 cases per 100 person years among people without arthritis.

While the rate of upper gastrointestinal problems in rheumatoid arthritis patients has gone down over the years, arthritis patients still had a higher risk of these upper gastrointestinal problems than those without arthritis (2.9 versus 1.7 cases per 100 person years, respectively).

The researchers also found links between lower gastrointestinal problems and smoking, the use of certain steroids, history of upper gastrointestinal disease, and abdominal surgery.

"There are many reasons people with rheumatoid arthritis have upper gastrointestinal problems," said Steven Z. Kussin, MD, FACP., author of Doctor, Your Patient Will See You Now, Gaining the Upper Hand in Your Medical Care and a gastroenterology expert who was not involved in the study.

"This article notes that there has been a significant drop in these complications (ulcer, bleeding and perforation)," he pointed out. "Good news, because these are associated with lower life expectancy according to the authors."

"When it comes to lower gastrointestinal problems of the colon, the news is not so hopeful," he said.

"Patients with rheumatoid arthritis vs. the control population without the disease, had up to more than double the incidence of lower intestinal perforation, infection and drug induced colonic inflammation compared to those without rheumatoid arthritis. The only factors this article was able to associate with a higher incidence of lower gastrointestinal problems was the use of tobacco, glucocorticoids and prior surgery.

"Sadly missing, was data regarding the lower gastrointestinal effects of the newer biologic agents. Many have indicted this class of agents with an increase incidence of inflammatory bowel disease, but rigorous proof is currently lacking in the literature. Doctors are only told to be aware of the potential association. Without this data the only recommendations are the basic calls to cease tobacco use and minimize the use of glucocorticoids," Dr. Kussin said.

Experts have known for a long time that rheumatoid arthritis can increase the risk of upper gastrointestinal problems like stomach ulcers. In addition, as Dr. Matteson explains, the results suggest the need to prevent ulcers and bleeding while controlling rheumatoid arthritis without using such a high amount of steroids

"What we are also seeing for the first time in a systematic way is that patients with rheumatoid arthritis also are at risk for problems of bleeding and ulcers in the lower gut, especially the colon," he says.

According to Dr. Kussin, "The take away message for doctors is to raise awareness. With vigilance, the complications, especially perforation, may be prevented rather than treated. And until the clinical information becomes available about the incidence of lower gastrointestinal problems on patients using biologic agents, there is little to add except the basic call to use the safest agents at the lowest dose."

Rheumatoid arthritis patients face a heightened risk of heart disease, lung disease, vision problems, and osteoporosis among many other problems. This Mayo Clinic study - which looked at data from 813 patients with rheumatoid arthritis and 813 without the condition - shows that lower gastrointestinal problems may need to be added to this list of serious complications.

According to Dr. Matteson, "Our findings emphasize that physicians and patients must be vigilant for these complications, which can occur without causing abdominal pain."

"Especially stopping smoking and reducing the use of corticosteroids would appear to be important in reducing the risk of major lower [gastrointestinal] complications," he says.

The results of the study were published online in The Journal of Rheumatology.

Reviewed by: 
Review Date: 
April 9, 2012
Last Updated:
August 26, 2012