EXTRAARTICULAR MANIFESTATIONS OF RHEUMATOID-ARTHRITIS - RISK-FACTORS FOR SERIOUS GASTROINTESTINAL EVENTS

Objectives-Serious upper gastrointestinal events are an important thre at to patients with arthritis who are treated with non-steroidal anti- inflammatory drugs (NSAIDs). In this study risk factors for serious up per gastroinestinal events are identified in patients with possible or definite rheumatoid arthritis (RA). Methods-A retrospective analysis of factors that might contribute to the risk of serious upper gastroin testinal events was performed in a cohort of 2315 consecutive patients with possible or definite RA. The relative influences of disease seve rity, drug treatment, particularly with corticosteroids, and history o f peptic ulceration were analysed with a conditional logistic regressi on model for the 106 patients with serious upper gastrointestinal even ts and for an equal number of control patients who were matched for ag e, gender, number of criteria for RA, and disease duration. Results-Th e incidence rate for serious upper gastrointestinal events was 4.0/100 0 patients in each year. The study reconfirmed that age over 60 years, history of peptic ulceration, and use of corticosteroids are risk fac tors. The presence of extra-articular manifestations of RA was associa ted with a two to 11-fold increase in the risk for serious upper gastr ointestinal events. This risk was independent of the use of corticoste roids. Conclusion-Disease severity, in particular the presence of extr a-articular features, may be an important factor in the pathogenesis o f upper gastrointestinal ulceration in patients with RA who are treate d with NSAIDs.