RESEARCH - Risk and predictors of adverse Gl events in RA and OA: a prospective 13 year study of 2131 patients

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J Rheumatol. 2000 Jul;27(7):1668-73.

The comparative risk and predictors of adverse gastrointestinal events

in rheumatoid arthritis and osteoarthritis: a prospective 13 year study

of 2131 patients.

Wolfe F, Hawley DJ.

Arthritis Research Center, National Data Bank for Rheumatic Diseases,

and the University of Kansas School of Medicine, Wichita, USA.

fwolfe@...

OBJECTIVE: It has been suggested that rheumatoid arthritis (RA) itself

may be a risk factor for adverse gastrointestinal (GI) events, but this

hypothesis has not been studied in a large sample, nor has the effect of

time on risk factors been studied. We investigated rates and risk

factors for GI events in RA and osteoarthritis (OA) and assessed the

additional risks conveyed by having RA. METHODS: A prospective study of

patients with OA and RA from a single center was undertaken using

questionnaires mailed at 6 month intervals. The relationship between

drug therapy and GI events was assessed in the same 6 month time frame.

Over 13 years of biannual assessments, 2,131 patients were studied for

serious GI events and adverse GI symptoms during 9,621 patient-years of

observation. RESULTS: The incidence rate (IR) for GI hospitalization was

1.56 and 1.28 per 100 patient-years, and for GI bleeding or perforation

was 0.50 and 0.58 for RA and OA, respectively. After controlling for

age, sex, nonsteroidal antiinflammatory drug (NSAID) and steroid use,

the incidence rate ratio (IRR) for RA versus OA did not differ for

hospitalization [iRR 1.07 (95% CI 0.66, 1.74)] or for bleeding or

perforation [iRR 0.63 (95% CI 0.29, 1.35)]. In multivariate analyses for

both groups combined, the IRR was 2.95 (2.05, 4.24) for prednisone use,

1.41 (1.08, 1.85) for NSAID use, and 1.46 (1.22, 1.74) for every 10 year

increase in age. In additional multivariate models, Health Assessment

Questionnaire disability was also a significant risk factor. During the

study period, the odds of NSAID use decreased 2.94 times per 10 year

period, while the odds of prednisone use increased by 1.49. Dysphagia

[iRR 1.11 (1.00, 1.24)], anorexia [iRR 1.13 (1.03, 1.23)], nausea [iRR

1.13 (1.04, 1.25)], heartburn [iRR 1.12 (1.05, 1.19)], vomiting [iRR

1.20 (1.02, 1.42)], peptic ulcer symptoms [iRR 1.20 (1.11, 1.29)], and

abdominal pain [iRR 1.11 (1.01, 1.22)] were associated with NSAID use,

but not with steroids.

CONCLUSION: Patients with RA and OA do not differ in the rates and risk

factors for GI hospitalizations and symptoms after controlling for age,

steroid use, NSAID use, or (for OA) body mass index. Prednisone is a

more important risk factor among patients with RA than NSAID.

PMID: 10914849

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=pubmed & dopt=Abstra\

ct & list_uids=10914849 & itool=iconabstr

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