Decreasing incidence of symptomatic gastrointestinal ulcers and ulcer complications in patients with rheumatoid arthritis

K SS Steen ^1*, M T Nurmohamed ¹, I Visman ², M Heierman ¹, M Boers ³, B AC Dijkmans ¹ and W F Lems ¹

¹ VU University medical center, Netherlands
² Jan van Breemen Institute, Netherlands
³ VUmc, Netherlands

^* To whom correspondence should be addressed. E-mail: k.steen{at}vumc.nl.

Accepted 21 June 2007

Abstract

Background: Nonsteroidal anti-inflammatory drugs (NSAIDs) frequently cause gastrointestinal (GI) ulcers and complications of ulcers. In 1997, in Amsterdam, the incidence of symptomatic GI events was 2.1% (95% C.I. 1.0-3.1) in patients with rheumatoid arthritis (RA). We conducted a second prospective, observational study on the symptomatic GI events in our outpatient clinics, and compared the data to our first study. At the same time a decline of GI events over the last decade was reported for US patients.

Methods: In 2003, three questionnaires were sent to all RA patients in Amsterdam in 4-month intervals, addressing medication use, dyspepsia, and symptomatic GI events in the previous 4 months.

Results: The incidence of GI events in high risk patients, defined as age 60 and/or history of GI event) using NSAIDs or COXIBs was 1.2% (95% C.I. 0.2-2.3) which appears to be substantially lower, than the 2.1% observed in 1997, albeit that this difference did not reach statistical significance (p=0.3). In 64% (95% C.I. 61-68) of the high risk patients, acid suppressive drugs, i.e. proton-pump inhibitors, prostaglandin analogs or high dose of H2-antagonists, were used. In 1997 this percentage was significantly lower, i.e. 49% (45-52; p<0.0001). The compliance to the Dutch guideline for prevention of NSAID related gastropathy was almost 75% with 64% of the patients used acid suppressive drugs and 11% used COXIBs.

Conclusion: The present study reveals a decline of NSAID induced gastrointestinal events, which is similar to that observed in the US. Most likely this is due to a more strict adherence to guidelines for prevention of NSAID gastropathy, and better treatment of rheumatoid arthritis.

Keywords: Gastrointestinal events, NSAID gastropathy, NSAIDs, Rheumatoid arthritis

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