Risk factors for the development of gastric mucosal lesions  in rheumatoid arthritis patients receiving long-term nonsteroidal  anti-inflammatory drug therapy and the efficacy of famotidine  obtained from the FORCE study.
The objective of this study was to investigate the prevalence of gastric mucosal injury induced by nonsteroidal anti-inflammatory drugs (NSAIDs) in patients with rheumatoid arthritis (RA). Upper gastrointestinal endoscopy was performed on 100 RA patients treated with NSAIDs. Patient factors potentially contributing to the development of NSAID-induced gastric mucosal injury were identified by logistic regression analysis; gastric mucosal injury and ulcers were used as objective variables. Gastric mucosal injury was detected in 62 of 100 patients, and eight of these patients had ulcers. Previous history of ulcers, lifestyle, NSAID dosage, and body mass index were associated with the development of gastric mucosal injury,and the use of diclofenac and steroid dose were associated with the development of ulcers. Disease-modifying antirheumatic drugs (DMARDs) did not appear to influence the risk of NSAID-induced gastric mucosal injury. RA patients treated for long periods with NSAIDs for RA symptoms should be controlled with DMARDs, without consideration of increased doses of steroids, in terms of risk for NSAID-induced gastric mucosal injury. Simultaneously, concomitant use of histamine-2 receptor antagonists (H2RA) such as famotidine should be considered.
Kobata
Yasunori
Y
Department of Orthopaedic Surgery, Nara Medical University,840 Shijo-cho, Kashihara, Nara 634-8522, Japan. ykobata@naramed-u.ac.jp
Yajima
Hiroshi
H
Yamao
Junichi
J
Tanaka
Yasuhito
Y
Fukui
Hiroshi
H
Takakura
Yoshinori
Y
D000328:Adult; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects* / Q000627:therapeutic use; D000897:Anti-Ulcer Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D015738:Famotidine / Q000627:therapeutic use*; D005260:Female; D005753:Gastric Mucosa / Q000293:injuries* / Q000473:pathology; D005773:Gastroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D012307:Risk Factors; D012720:Severity of Illness Index; D013272:Stomach Diseases / Q000139:chemically induced* / Q000473:pathology; D016896:Treatment Outcome
D000894:Anti-Inflammatory Agents, Non-Steroidal; D000897:Anti-Ulcer Agents; D015738:Famotidine