Life threatening gastrointestinal tract complications in a patient of rheumatoid arthritis. Is it drug or disease related?

  • Kanisha Shah Smt. NHL Municipal Medical College, Ahmedabad, Gujarat, India.
  • Sapna D. Gupta Smt. NHL Municipal Medical College, Ahmedabad, Gujarat, India.
  • Supriya D. Malhotra Smt. NHL Municipal Medical College, Ahmedabad, Gujarat, India.
Keywords: Gastrointestinal perforation, Rheumatoid Arthritis, Glucocorticoids

Abstract

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.

Author Biographies

Kanisha Shah, Smt. NHL Municipal Medical College, Ahmedabad, Gujarat, India.

Resident doctor, Department of Pharmacology.

Sapna D. Gupta, Smt. NHL Municipal Medical College, Ahmedabad, Gujarat, India.

Associate Professor, Department of Emergency Medicine.

Supriya D. Malhotra, Smt. NHL Municipal Medical College, Ahmedabad, Gujarat, India.

Professor and Head, Department of Pharmacology.

References

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.

Published
2022-09-01
How to Cite
1.
Shah K, Gupta SD, Malhotra SD. Life threatening gastrointestinal tract complications in a patient of rheumatoid arthritis. Is it drug or disease related?. jpadr [Internet]. 2022Sep.1 [cited 2022Sep.27];3(3):51-3. Available from: https://jpadr.com/index.php/jpadr/article/view/87