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  • Publication # 13-RA012

Several rheumatoid arthritis drugs are associated with gastrointestinal perforation

Chronic Disease

Although rare, gastrointestinal (GI) perforation is a serious condition that affects patients with rheumatoid arthritis (RA). A new study reveals that the risk of GI perforation in patients with RA varies with the medications used to treat their arthritis. The researchers retrospectively analyzed data on adults with RA from a large U.S. health plan database. The researchers also identified patients who were hospitalized for upper or lower GI perforation. 

Data on medical and pharmaceutical expenditures furnished information on specific medications patients were taking to treat their RA. The final analysis included 143,433 patients. There were 696 hospitalizations for perforations. The majority (83 percent) of perforations occurred in the lower GI tract. The rate of perforation was 1.70 per 1,000 person-years. Perforations in the upper GI tract were associated with gastric and duodenal ulcers. Those in the lower GI tract were associated with diverticulitis and appendicitis. The majority of patients (91 percent) received some medications for RA.

The most popular drugs were nonsteroidal anti-inflammatory drugs (NSAIDs), glucocorticoids, methotrexate, disease-modifying antirheumatic drugs (DMARDs), and biologic agents. Use of glucocorticoids and NSAIDs was associated with GI perforation. Other identified risk factors were old age, a history of diverticulitis, and multiple coexisting medical conditions. Diverticulosis without diverticulitis and the use of biologic agents like tumor-necrosis-factor-inhibitors (anti-TNF therapy), were not risk factors for GI perforation. In diverticulosis, pouches develop in the wall of the colon. If the opening to a pouch becomes obstructed, infection and inflammation of the wall of the pouch, painful diverticulitis, may occur. 

The researchers suggest that clinicians use caution when prescribing glucocorticoids or NSAIDs in aged patients and in those with a history of diverticulitis. The study was supported in part by AHRQ (HS18517).

See "Factors associated with gastrointestinal perforation in a cohort of patients with rheumatoid arthritis," by Jeffrey R. Curtis, M.D., M.S., M.P.H., Angel Lanas, M.D., D.Sc., Ani John, B.S.N., M.P.H., and others in the December 2012 Arthritis Care & Research 64(12), pp. 1819-1828.


Page last reviewed September 2013
Internet Citation: Several rheumatoid arthritis drugs are associated with gastrointestinal perforation: Chronic Disease. September 2013. Agency for Healthcare Research and Quality, Rockville, MD.


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