RESEARCH - Decreasing incidence of symptomatic GI ulcers and ulcer complications in patients with RA

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Ann Rheum Dis. 2008 Feb;67(2):256-9. Epub 2007 Jun 29.

Decreasing incidence of symptomatic gastrointestinal ulcers and ulcer

complications in patients with rheumatoid arthritis.

Steen KS, Nurmohamed MT, Visman I, Heijerman M, Boers M, Dijkmans BA, Lems WF.

Department of Rheumatology, VU University Medical Center, Boelelaan

1117, 1081 HV, Amsterdam, The Netherlands.

BACKGROUND: Non-steroidal anti-inflammatory drugs (NSAIDs) frequently

cause gastrointestinal (GI) ulcers and complications of ulcers. In

1997 in Amsterdam, the incidence of symptomatic GI events was 2.1%

(95% CI 1.0-3.1) in patients with rheumatoid arthritis (RA). We

conducted a new prospective, observational study on the symptomatic GI

events in our outpatient clinics, and compared the data to a previous

study conducted by our group. Over the same time period, a decline of

GI events over the last decade was reported for US patients. METHODS:

In 2003, three questionnaires were sent to all RA patients in

Amsterdam at 4-month intervals, addressing medication use, dyspepsia,

and symptomatic GI events in the previous 4 months. RESULTS: The

incidence of GI events in high-risk patients, defined as age >or=60

and/or history of GI event) using NSAIDs or cyclo-oxygenase 2 specific

inhibitors (COXIBs) was 1.2% (95% CI 0.2-2.3), which appears to be

substantially lower than the 2.1% observed in 1997; however this

difference did not reach statistical significance (p = 0.3). In 64%

(95% CI 61-68) of the high-risk patients, acid-suppressive drugs (ie,

proton pump inhibitors, prostaglandin analogues or high dose H2

antagonists) were used. In 1997 this percentage was significantly

lower at 49% (45-52; p<0.001). The compliance to the Dutch guidelines

for prevention of NSAID-related gastropathy was almost 75%, with 64%

of the patients using acid-suppressive drugs and 11% using COXIBs.

CONCLUSION: The present study reveals a decline of NSAID-induced

gastrointestinal events, which is similar to the results observed in

the US. This is most likely due to a more strict adherence to

guidelines for prevention of NSAID gastropathy, and better treatment

of rheumatoid arthritis.

PMID: 17604285

http://www.ncbi.nlm.nih.gov/pubmed/17604285

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