Rheumatoid arthritis and gastrointestinal tract lesions (NSAID ulcers, amyloidosis)

Abstract

This chapter discusses the relationship of rheumatoid arthritis (RA) to nonsteroidal anti-inflammatory drug (NSAID)-associated ulcers and intestinal amyloidosis, both of which are gastrointestinal tract lesions. NSAID ulcers associated with RA are not as common as they once were. There are three reasons for this. First, the role of NSAIDs in rheumatoid arthritis treatment has changed. Second, NSAIDs less damaging to the intestines have become available. Third, there is now much greater awareness of NSAID ulcers. Changes in the role of NSAIDs are attributable to less and shorter-term use of NSAIDs, which were previously used widely and for a long time to treat inflammation, thanks to the appearance of antirheumatic drugs and biological products. NSAIDs less damaging to the intestines that are now available include NSAIDs that selectively inhibit cyclooxygenase (COX) 2. These were developed after it was found that COX-1, to which conventional NSAIDs bind to reduce inflammation and pain, helps protect the stomach lining. Finally, with greater awareness of the gastrointestinal damage NSAIDs cause has come greater focus on preventing ulcers. Health insurance now covers prophylactic proton pump inhibitors, which are widely used to treat gastric ulcers, for high-risk patients. The result has been a significant drop in ulcers. Almost all amyloidosis associated with RA is AA amyloidosis, which is known as secondary or reactive amyloidosis. As these names suggest, amyloidosis occurs secondarily during the course of RA and other chronic inflammatory diseases. Progress in RA treatment has made long-term control of inflammation possible in more patients and, consequently, less amyloidosis occurring in association with the disease. Even so, patients treated for RA should undergo regular screening for AA amyloidosis and be checked for clinical symptoms so that AA amyloidosis can be detected early. This chapter describes in detail RA-associated NSAID ulcers and amyloidosis, which, although now less common, remain as risks to RA patients.