Life threatening gastrointestinal tract complications in a patient of rheumatoid arthritis. Is it drug or disease related?
Introduction: Gastrointestinal (GI) complications are very frequent and sometimes fatal in patients with Rheumatoid Arthritis (RA). Gastrointestinal perforation is a rare but serious event, most frequently involving the lower GIT, which has been observed in patients with RA.
Case Presentation: We present here an Adverse Drug Reaction (ADR) which is small bowel ischemia with perforation in a 61-year-old RA patient, who was taking a tablet of Prednisolone and tablet Hydroxychloroquine.
Discussion: Several studies indicated that RA patients may be at a higher risk of GI perforation. This could be attributed to the disease pathophysiology or the use of drugs for treatment like Glucocorticoids and Non-Steroidal Anti-Inflammatory Drugs (NSAIDs). Rheumatologists must be vigilant for GI complications while prescribing anti-rheumatoid drugs.
Conclusion: GI perforations are rare events in RA patients, but cause significant morbidity and mortality. Increasing age and other comorbid conditions also increase the risk of adverse GI events.
Berman, S., Bucher, J., Koyfman, A., & Long, B. J. (2018). Emergent Complications of Rheumatoid Arthritis. The Journal of emergency medicine, 55(5), 647–658.
Curtis, J. R., Lanas, A., John, A., Johnson, D. A., & Schulman, K. L. (2012). Factors associated with gastrointestinal perforation in a cohort of patients with rheumatoid arthritis. Arthritis care & research, 64(12), 1819–1828.
Curtis, J. R., Xie, F., Chen, L., Spettell, C., McMahan, R. M., Fernandes, J., & Delzell, E. (2011). The incidence of gastrointestinal perforations among rheumatoid arthritis patients. Arthritis and rheumatism, 63(2), 346–351.
Jagpal, A., & Curtis, J. R. (2018). Gastrointestinal Perforations with Biologics in Patients with Rheumatoid Arthritis: Implications for Clinicians. Drug safety, 41(6), 545–553.
Wang, W., Zhou, H., & Liu, L. (2018). Side effects of methotrexate therapy for rheumatoid arthritis: A systematic review. European journal of medicinal chemistry, 158, 502–516.
Copyright (c) 2022 Kanisha Shah, Sapna D. Gupta, Supriya D. Malhotra
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.