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Gastrointestinal Problems Tied to Rheumatoid Arthritis

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A recent Mayo Clinic study has concluded that rheumatoid arthritis warrants more attention regarding not just the upper gastrointestinal problems that often plague patients, but also the many lower GI conditions that appear.

These lower GI problems include ulcers, bleeding and perforations, especially in the colon.

Rheumatoid arthritis patients are at greater risk for GI problems and gastrointestinal-related death than people without the disease, stated an April 3, 2012, Mayo Clinic press release. Upper GI problems have actually decreased among RA patients, thanks to greater understanding of the side effects of traditional arthritis medications. But the incidence of lower GI complications is rising, the Mayo says.

The clinic’s research, published in The Journal of Rheumatology, points to smoking, the use of glucocorticoids (steroids), prior upper GI disease and abdominal surgery as being associated with lower GI conditions in RA patients.

The study involved 813 patients with rheumatoid arthritis and 813 without it. For both upper and lower GI problems, those with RA showed a greater incidence than those without RA, although the numbers indicated that there had been a decline over the years in specifically upper GI problems.

Of the arthritis patients studied, however, 229 died, and GI problems were a significant factor, presenting themselves as bleeding, perforations and obstructions.

“Our findings emphasize that physicians and patients must be vigilant for these complications, which can occur without causing abdominal pain," said Dr. Eric Matteson, coauthor of the study and chair of Mayo’s Department of Rheumatology in Rochester, Minn.

“Especially stopping smoking and reducing the use of corticosteroids would appear to be important in reducing the risk of major lower GI complications," he added.

Rheumatoid arthritis is a chronic inflammatory disease of the joints that affects an estimated 1.3 million Americans, according to the Arthritis Foundation.

RA occurs when the body’s immune system mistakenly attacks the membrane lining the joints, resulting in pain and inflammation, joint damage and even disability. The causes of this autoimmune disease are seen as a combination of genetics and environmental factors.

Beyond joint problems, though, RA can affect the skin, heart, blood cells, blood vessels, nervous system and lungs.

An article in Arthritis Today points out that the side effects of RA can be alarming, but these complications are more likely to happen in patients who have had moderate to severe RA for a long time or in those patients whose RA has not been well-controlled with medication.

In recent years, by looking at RA’s effect on the upper gastrointestinal tract, doctors have changed treatment protocols regarding NSAIDS, or nonsteroidal anti-inflammatory drugs, because the drugs have been associated with stomach upset and stomach ulcers.

Corticosteroids also have side effects, including elevated blood fats and blood sugar levels, according to Arthritis Today. Because they are potent and quick-acting medications, corticosteroids often are prescribed in low doses for short amounts of time to bring inflammation under control.


“Lower GI Problems Plague Many With Rheumatoid Arthritis, Mayo Clinic Study Finds.” Mayo Clinic. Web. 16 April 2012.

“More Than Just Joints: How Rheumatoid Arthritis Affects the Rest of Your Body.” Arthritis Today. Web. 16 April 2012. http://www.arthritistoday.org/conditions/rheumatoid-arthritis/all-about-ra/rhemuatoid-arthritis-affects-body.php

“Side Effects of RA Medications.” Arthritis Today. Web. 16 April 2012. http://www.arthritistoday.org/conditions/rheumatoid-arthritis/ra-treatment/ra-side-effects.php

Reviewed April 17, 2012
by Michele Blacksberg RN
Edited by Jody Smith

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