Evaluation of small bowel injury in patients with rheumatoid arthritis by capsule endoscopy: effects of anti-rheumatoid arthritis drugs.
OBJECTIVE
The medical treatment of rheumatoid arthritis (RA) includes nonsteroidal anti-inflammatory drugs (NSAIDs), low-dose corticosteroids, and disease-modifying antirheumatic drugs (DMARDs). We evaluated the incidence of small bowel injury in RA patients who were taking anti-RA drugs with or without concomitant NSAIDs by capsule endoscopy.


METHODS
A total of 28 RA patients who took low-dose corticosteroids and/or DMARDs for more than 1 year were enrolled.


RESULTS
The incidence of red spots did not differ between the 2 groups: 14 of 16 patients (87.5%) in the NSAID group and 11 of 12 patients (91.7%) in the non-NSAID group. In contrast, the incidence of mucosal breaks was significantly higher in the NSAID group than in the non-NSAID group: mucosal breaks were detected in 13 of 16 patients (81.3%) and 4 of 12 patients (33.3%) in the NSAID and non-NSAID groups, respectively. In the NSAID group, mucosal breaks developed in users of preferential cyclooxygenase-2 inhibitors at a frequency similar to that in users of traditional NSAIDs.


CONCLUSIONS
Patients taking anti-RA drugs may have an increased frequency of small bowel injury regardless of NSAID use, and NSAID use may be associated with an increased incidence of severe small bowel injury.
Sugimori
Satoshi
S
Department of Gastroenterology, Osaka City University Graduate School of Medicine, Abeno-ku, Osaka, Japan.
Watanabe
Toshio
T
Tabuchi
Masahiko
M
Kameda
Natsuhiko
N
Machida
Hirohisa
H
Okazaki
Hirotoshi
H
Tanigawa
Tetsuya
T
Yamagami
Hirokazu
H
Shiba
Masatsugu
M
Watanabe
Kenji
K
Tominaga
Kazunari
K
Fujiwara
Yasuhiro
Y
Oshitani
Nobuhide
N
Koike
Tatsuya
T
Higuchi
Kazuhide
K
Arakawa
Tetsuo
T
D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000009:adverse effects*; D000328:Adult; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects; D018501:Antirheumatic Agents / Q000009:adverse effects*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D053704:Capsule Endoscopy / Q000009:adverse effects*; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D015994:Incidence; D007413:Intestinal Mucosa / Q000293:injuries / Q000473:pathology; D007421:Intestine, Small / Q000293:injuries* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D014947:Wounds and Injuries / Q000453:epidemiology / Q000209:etiology / Q000473:pathology
D000305:Adrenal Cortex Hormones; D000894:Anti-Inflammatory Agents, Non-Steroidal; D018501:Antirheumatic Agents