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

• Published in: Rheumatology international Vol. 36; no. 11; pp. 1557 - 1561
• Main Authors: Tachecí, Ilja, Bradna, Petr, Douda, Tomáš, Baštecká, Drahomíra, Kopáčová, Marcela, Rejchrt, Stanislav, Lutonský, Martin, Soukup, Tomáš, Bureš, Jan
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.11.2016; Springer Nature B.V
• Subjects: Adult; Anti-Inflammatory Agents, Non-Steroidal - adverse effects; Anti-Inflammatory Agents, Non-Steroidal - therapeutic use; Arthritis, Rheumatoid - drug therapy; Capsule Endoscopy; DRKS; DRKS00004940; Female; Humans; Intestinal Diseases - chemically induced; Intestinal Diseases - diagnostic imaging; Intestinal Diseases - epidemiology; Intestine, Small - diagnostic imaging; Male; Medicine; Medicine & Public Health; Middle Aged; Osteoarthritis - drug therapy; Prevalence; Prospective Studies; Rheumatology; Safety and Pharmacovigillance; Surveys and Questionnaires; Enteropathy; Small bowel; Wireless capsule endoscopy; Osteoarthritis; Non-steroidal anti-inflammatory drug; Rheumatoid arthritis
• ISSN: 0172-8172; 1437-160X; 1437-160X
• DOI: 10.1007/s00296-016-3552-x

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.