Steroids Up Risk of Bowel Perforation in Arthritis Patients

Increased risk for RA patients taking glucocorticoids or with a history of diverticulitis

WEDNESDAY, Feb. 16 (HealthDay News) -- Rheumatoid arthritis (RA) patients treated with glucocorticoids or with a history of diverticulitis have increased risk of gastrointestinal (GI) perforation, according to a study in the February issue of Arthritis & Rheumatism.

Jeffrey R. Curtis, M.D., M.P.H., from the University of Alabama in Birmingham, and colleagues identified 40,841 RA patients from a large U.S. health insurance plan. The risk of GI perforation was assessed according to types of treatment: biologic agents, methotrexate (MTX), oral glucocorticoids, and nonsteroidal anti-inflammatory drugs (NSAIDs). Additional risk factors and incidence rates were evaluated.

The investigators identified 37 hospitalizations of RA patients with GI perforation. The rate of perforation was higher among patients treated with biologic agents and oral glucocorticoids, compared to those treated with biologic agents alone, or those treated with MTX and glucocorticoids. Treatment with glucocorticoids and NSAIDs together, or glucocorticoids alone, was associated with GI perforation, but not treatment with biologic agents or MTX alone. Diverticulitis was identified as a strong risk factor for perforation. Seventy percent of patients who had a GI perforation were treated with glucocorticoids, had a history of diverticulitis, or both.

"In conclusion, our results provide context in evaluating the rates and risk factors for GI perforation in future safety studies of medications for RA. Patients who are not being treated with glucocorticoids and who do not have diverticulitis appear to be at very low risk for this event," the authors write.

One author disclosed financial relationships with the pharmaceutical industry.

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