The risk of developing any GI event was 70 percent higher in those with RA than in those without RA (162 GI events among RA patients vs. 124 GI events among those without RA). When broken down into upper- and lower-GI events, the risks for someone with RA were 70 percent and 50 percent higher, respectively (154 upper- and 129 lower-GI events among RA patients vs. 110 upper- and 99 lower-GI events among controls).

In particular, people with RA had an increased risk of infectious colitis (inflammation of the colon caused by infection) and drug-induced colitis, as well as lower-GI bleeding, perforation and diverticulitis, compared with non-RA patients. And when GI events occurred, they were more likely to be serious and require hospitalization in people with RA than in those without RA.

The researchers also found that the incidence of any upper-GI event among RA patients fell significantly – from more than 4.5 per 100 person-years to fewer than 2 per 100 person-years – during the study period. (“Person-years” is a measurement of how often an event occurs. In the last example, if you were to follow 100 people for one year, statistically fewer than 2 would develop an upper-GI issue.)

But, the authors write, “there has been no significant improvement in incidence of lower-GI events, particularly in RA,” and suggest that better strategies and treatment approaches are needed to address lower-GI problems in people with RA. Such strategies include timely treatment of upper-GI disease, minimizing exposure to glucocorticoids (such as cortisone and prednisone), avoiding smoking, and screening for lower-GI disease, all of which may help reduce the incidence or seriousness of lower-GI issues.

“We know that people with RA have an increased risk of GI events and deaths due to those events,” says Gregg Silverman, MD, professor of medicine and pathology and co-director of the Center of Excellence on Musculoskeletal Disease at NYU School of Medicine in New York City. He was not involved in the study. “The take-home message of this study is that, although the impact of the disease and its treatments on the GI tract is changing, GI problems are not going away in patients with RA.”

“Patients should be aware that RA can have complications involving the lower-GI tract that can lead to serious complications, and that the medications for RA may cause or amplify related adverse events. To minimize this risk, patients should quit smoking and be vigilant for any GI symptoms, such as black, tarry stool, and seek medical attention if this occurs,” says Dr. Silverman.