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Rheumatol Int. 2016 Nov;36(11):1557-1561. Epub 2016 Aug 22.

Small intestinal injury in NSAID users suffering from rheumatoid arthritis or osteoarthritis.

Author information

1
Second Department of Internal Medicine - Gastroenterology, Faculty of Medicine at Hradec Králové, University Hospital, Charles University in Prague, Sokolská 581, 50003, Hradec Králové, Czech Republic. tacheci@gmail.com.
2
Second Department of Internal Medicine - Gastroenterology, Faculty of Medicine at Hradec Králové, University Hospital, Charles University in Prague, Sokolská 581, 50003, Hradec Králové, Czech Republic.
3
Department of Orthopaedic Surgery, Faculty of Medicine at Hradec Králové, University Hospital, Charles University in Prague, Sokolská 581, 50003, Hradec Králové, Czech Republic.

Abstract

The goal of this prospective study was to assess non-steroidal anti-inflammatory drug (NSAID)-induced enteropathy in patients with rheumatoid arthritis (RA) or osteoarthritis (OA) by means of non-invasive wireless capsule enteroscopy. A total of 143 patients (74 with RA, 69 with OA) treated with NSAIDs (>1 month) and 42 healthy volunteers were included. All subjects underwent capsule endoscopy, laboratory tests and filled in questionnaires. The severity of small bowel injury was graded as: mild (red spots or sporadic erosions), moderate (10-20 erosions) or severe (>20 erosions or ulcers). Capsule endoscopy identified small bowel lesions in 44.8 % of patients (mild 36.4 %, moderate 3.5 % and severe in 4.9 %). Mild non-specific lesions were found in 11.9 % healthy volunteers. There was a significantly higher prevalence of enteropathy in RA (56.8 %) compared to OA (31.9 %, p < 0.01). A significant difference between NSAID users (RA and OA) with and without enteropathy was observed in erythrocytes (p < 0.01), the leucocyte count (p < 0.05), haemoglobin (p < 0.05), haematocrit (p < 0.05), serum albumin (p < 0.01) and erythrocyte sedimentation rate (p < 0.05). No relationship was found between enteropathy and dyspepsia, gender or age. NSAID therapy is associated with a significant risk of small bowel injury. The risk is significantly higher in RA patients suggesting a possible influence of the underlying disease.

TRIAL REGISTRATION NUMBER:

DRKS00004940.

KEYWORDS:

Enteropathy; Non-steroidal anti-inflammatory drug; Osteoarthritis; Rheumatoid arthritis; Small bowel; Wireless capsule endoscopy

PMID:
27549792
PMCID:
PMC5055563
DOI:
10.1007/s00296-016-3552-x
[Indexed for MEDLINE]
Free PMC Article

Conflict of interest statement

We certify that there is no conflict of interest with any financial organisation regarding the material discussed in the manuscript. Ethical approval The project was approved by Joint University Ethical Committee. All procedures were performed in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its latter amendments. Informed consent Informed consent was obtained from individual participants included in the study.

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