According to the Arthritis Foundation, if you have rheumatoid arthritis and also have tummy troubles, you’re in good company.
Research indicates that people with RA also have more digestive problems than those who do not suffer from the disease. A 2012 study published in the Journal of Rheumatology found RA patients have a 70 percent higher risk of developing a gastrointestinal problem compared with the general population. Constipation is an issue in 66 percent of people studied, and diarrhea afflicts 11 percent.
Digestive problems are divided into two categories, depending on whether they occur in the upper or lower gastrointestinal tracts.
Upper GI events, which occur between the mouth and the end of the stomach, include bleeding, a hole — or perforation — in the wall of the stomach, ulcers, obstruction and esophagitis, which is characterized by inflammation, irritation or swelling of the esophagus.
Lower GI events, which occur in the large and small intestines, include 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).
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The 2012 study also found that when GI events occur, they are more likely to be serious and require hospitalization in people with RA compared with the general public.
There are several possible reasons why RA and gastrointestinal problems go hand in hand. One of these is inflammation.
RA is an autoimmune disease in which the body’s immune system produces several proteins — called cytokines — that cause widespread inflammation and attack healthy tissue lining the joints, as well as other organ systems throughout the body. This inflammation may also cause digestive upset.
“There may be an association between RA disease activity and digestive issues,” says Dr. Arina Garg, a rheumatologist in Brooklyn, New York. “However, there is very limited data on RA as an underlying cause of gastrointestinal symptoms, although some studies have found increased prevalence of abdominal pain, nausea, fullness [upon eating] and stool leakage in patients with RA as compared to non-RA subjects,” she explains.
The medications used to treat RA are another culprit. The non-steroidal anti-inflammatory drugs like ibuprofen, corticosteroids like prednisone and disease-modifying antirheumatic drugs like methotrexate commonly cause GI problems.
“Most RA patients will have GI complications related to medications,” says Dr. Joseph Huffstutter, a rheumatologist in Hixson, Tennessee, and a clinical assistant professor of medicine at The University of Tennessee Health Science Center. “The most common complications are gastritis, peptic ulcer disease, bowel inflammation, diarrhea and reflux disease,” he says.
” Smoking can further increase the risk of [GI problems] in patients with RA who are on these medications,” Garg adds.
Fibromyalgia may also be to blame. As many as 30 percent of individuals with RA develop fibromyalgia, a condition that is typically associated with abdominal pain, bloating and irritable bowel syndrome or spastic colon.
An area of growing interest is the microbiota and microbiome of the intestines and the mouth and the role they may play in the development of a host of diseases, including RA and gastrointestinal disorders. The University of Utah Genetic Science Learning Center defines microbiota as the collection of microbes — bacteria, fungi and viruses — that live in a specific environment. The microbiome refers to all of the genes contained within the microbiota.
Antibiotics, infection, illness and other factors can upset the normal composition of the microbiota. Researchers increasingly believe that changes in the normal composition of the body’s microbiota can trigger a cascade of events that may lead to disease.
“Accumulating evidence suggests that the oral and intestinal microbiomes have a role in the development of RA,” Garg says.
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“How the immune system responds is an intense point of interest and is the subject of intense study, as in the National Institutes of Health’s [Human] Microbiome Project,” Huffstutter says. The hope is that research will eventually identify why these diseases develop, which could lead to better treatments.
Overall, “most gastrointestinal symptoms are related to medication use,” Garg notes. “Patients with RA should not be hesitant to discuss their gastrointestinal side effects with their doctors so that their therapy can be adjusted or switched, before they develop serious symptoms,” she advises.
This advice also pertains to the use of over-the-counter medications like ibuprofen and naproxen.
“Patients should be careful about the use of [these] medications, making sure to take them with full meals and not to exceed the maximum daily dose,” she says.
It is also advisable to take a proton pump inhibitor like Prilosec while taking medications that can cause gastrointestinal upset, especially if you must take them over the long term. These drugs reduce the amount of stomach acid produced by the glands lining the stomach.
“In patients who are unable to tolerate disease-modifying antirheumatic drugs because of severe gastrointestinal side effects, treatment with biologic medications may be considered to treat their RA,” Garg says.
Garg also advises smokers to quit because smoking can exacerbate both gastrointestinal symptoms and overall RA disease activity.
“As long as patients are vigilant about their medication use, most of the GI symptoms in RA patients can be prevented,” Garg notes.
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Huffstutter agrees.
“Take the medications exactly as prescribed, report new symptoms promptly, stop smoking, avoid certain foods that may cause GI distress and limit alcohol,” he advises, adding that “caring for RA patients is challenging because of the myriad symptoms, medications and coexisting health conditions [that accompany the disease]. It is imperative that patients find a knowledgeable provider whom they trust and can communicate with. It is a partnership that should last many years,” he notes.
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Got Rheumatoid Arthritis? Expect Tummy Troubles originally appeared on usnews.com
