Gastritis and Rheumatoid Arthritis
The stomach might be the last thing you would think about when considering rheumatoid arthritis (RA) but it is a serious concern for many patients. We need to remember that RA is a whole body or systemic illness and can affect any organ or system. This is what is called an autoimmune disease, which means that the immune system becomes confused and attacks its own tissues. In RA, the tissues of the stomach are among the targets that can be damaged by the disease.
As many as 63% of those diagnosed with rheumatoid arthritis will suffer from gastritis and other stomach problems during the course of their disease. The stomach is often under attack from two different directions in RA because both the disease itself and the medications used in treatment can negatively affect the stomach. Stomach ulcers are often associated with RA and not only cause pain and risk themselves but can also increase the risk of developing stomach cancer later on. In fact, chronic gastritis of any kind can increase the stomach cancer risk. Thus it is truly important to treat gastritis as more than just an annoyance.
The symptoms of gastritis associated with RA are fairly easy to recognize. Abdominal pain located in the left upper quadrant is the single most common symptom but may be accompanied by nausea, vomiting, belching and bloating. A burning sensation may be felt in the general area and can even seem to be chest pain. (Since heart problems can coexist with RA and other conditions, any chest pain should be discussed with a doctor. Never assume it is “just gastritis.”) Some foods may make the gastritis worse and others may seem to soothe it. Over the counter antacids may be enough to relieve mild cases, but it is most important to deal with the underlying cause.
NSAIDs (non-steroidal anti-inflammatory drugs) are often responsible for gastritis in even people with RA or some other autoimmune condition. Fortunately there are other medications less likely to cause such problems, but for those who need NSAIDs there is help. A drug called misoprostol (brand name Cytotec) helps prevent the gastritis caused by NSAIDs and protects the stomach. The drawback to this drug is that it is dangerous in pregnancy and can cause miscarriage, premature labor and birth defects in surviving infants. Thus those who are pregnant or who can become pregnant should not take this drug.
Other conditions may be associated with RA-related gastritis. When the stomach tissue is damaged, the ability to absorb nutrients is impacted and deficiency illnesses can result. One such condition is pernicious anemia, an inability to absorb the essential nutrient B-12. This will need to be given as a supplement, often by injection, in such cases. Sometimes the stomach stops making hydrochloric acid in RA and this also makes digestion less effective. Some patients require supplements to treat this as well. Patients with RA gastritis need the support of nutritionists, rheumatologist and gastroenterologists as well for complete and effective treatment.
Since well more than half of all RA patients develop gastritis, it is a significant illness that needs to be considered. Patients with RA also seem to be more likely to contract H. pylori and C. pylori bacterial infections that lead to ulcers, so this needs to be considered as well, and those who have chronic gastritis despite treatment need regular screening for stomach cancer. Like many of the complications of rheumatoid arthritis, gastritis can usually be effectively treated. It is simply one of the issues associated with living with RA.
Resources
General information about gastritis: www.revolutionhealth.com/conditions/digestive/gastritis/
Information about RA associated gastritis: www.linkroll.com/rheumatoid-arthritis-treatment/
Seronegative JRA and mast cell gastritis: http://www.ncbi.nlm.nih.gov/pubmed/1670619
General information about RA and gastritis, associated achlorhydria: www.diagnose-me.com/cond/C62119.html
Information about complications of autoimmune gastritis: www.gicare.com/pated/ecdgs46.htm
Information about misoprostol (Cytotec): http://www.nlm.nih.gov/medlineplus/