A study published online in the Journal of Rheumatology adds new insight to the well-known link between rheumatoid arthritis, or RA, and gastrointestinal, or GI, problems, such as bleeding and ulcers.

It found that the incidence of upper-GI tract problems – occurring between the mouth and the end of the stomach – declined over the 28-year study period in people with RA. On the other hand, the incidence of lower-GI tract problems in people with RA – affecting the large and small intestines – held steady over the same time period.

Upper-GI problems in RA patients have been partly attributed to the use of nonsteroidal anti-inflammatory drugs, or NSAIDs. “An increased awareness of the [side effects of] NSAIDs, wiser use of NSAIDs when they are needed … and use of proton pump inhibitors to control upper-GI symptoms have helped to reduce the incidence of upper-GI problems associated with RA,” says study co-author Eric Matteson, MD, chair of rheumatology at the Mayo Clinic in Rochester, Minn.

Although less research has focused on the link between lower-GI problems and RA – this study identified factors associated with a higher risk of developing those problems. Factors include smoking, use of corticosteroids (i.e., prednisone, cortisone), prior upper-GI disease and abdominal surgery. “We are still seeing about a 50 percent increase in lower-GI problems in people with RA compared with those without it. More attention is needed to address lower-GI problems,” says Dr. Matteson. “Doctors and patients should be aware of the increased risk of lower-GI problems that can be related to RA and/or its treatments, and of the risk factors that can lead to lower-GI problems. Stopping smoking and avoiding corticosteroids can reduce the risk.”

The study confirms that, overall, people with RA have more upper- and lower-GI problems and are more likely to die of GI problems than people who do not have the disease. Experts suspect impaired immunity due to the disease plays a role.

The study compared 813 people diagnosed with RA with 813 age- and sex-matched people who did not have RA, all from the same county in Minnesota, and followed them for about 10 years. Upper-GI events included bleeding, GI perforation (a hole in the wall of the stomach or the small or large intestine), ulcers, obstruction and esophagitis (inflammation, irritation or swelling of the esophagus). Lower-GI events included bleeding, perforation, ulcers, obstruction, diverticulitis (infection or inflammation of the small sacs in the lining of the intestine) and colitis (swelling of the large intestine).