Gastrointestinal Perforation Rare in Rheumatoid Arthritis

Main risk factors for GI perforations include age, history of diverticulitis, glucocorticoid use

FRIDAY, July 6 (HealthDay News) -- Gastrointestinal (GI) perforation is a rare but serious condition that affects patients with rheumatoid arthritis (RA), most frequently in the lower GI tract, according to a study published online June 21 in Arthritis Care & Research.

Jeffrey R. Curtis, M.D., M.P.H., from the University of Alabama at Birmingham, and colleagues analyzed health insurance claims data to identify the incidence and risk factors for GI perforation among 143,433 RA patients.

Using a maximally sensitive definition for GI perforation, the researchers identified 696 hospitalizations with perforation, representing a rate of 1.70 per 1,000 person-years, which was lower when a more specific definition was used (0.87 per 1,000 person years). Eighty-three percent of perforations occurred in the lower GI tract. Age and diverticulitis were the strongest risk factors for perforation (hazard ratios for diverticulitis: 14.5 for the more sensitive definition and 3.9 for the more specific definition). The risk of GI perforation was highest among patients with exposure to concomitant non-biologic disease-modifying antirheumatic drugs and glucocorticoids, compared to methotrexate. Use of biologics without glucocorticoids was not a risk factor.

"Clinicians should be aware of risk factors for GI perforation when managing RA patients, including age, history of diverticulitis, and use of glucocorticoids or nonsteroidal anti-inflammatory drugs," the authors write.

Several authors disclosed financial ties to pharmaceutical companies; one author is an employee of Genentech.

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