Steroids increase bowel perforation risk for RA

Rheumatoid arthritis patients who have been treated with glucocorticoids have an increased risk of gastrointestinal perforation, according to a study published in Arthritis & Rheumatism.

Researchers at the University of Alabama in Birmingham and other facilities evaluated the risk of GI perforation in 40,841 rheumatoid arthritis patients from the databases of a large U.S. health insurance plan. The researchers assessed patients by treatment types, including oral glucocorticoids, nonsteroidal anti-inflammatory drugs, biologic agents, and methotrexate (MTX). They also identified patients who suffered from diverticulitis.

The rate of GI perforation among patients being treated with oral glucocorticoids plus biologic agents was higher (1.12 per 1,000 person years [95% CI, 0.50-2.49]) than for patients being treated with biologic agents alone (.47 per 1,000 person-years [95% CI, 0.36-2.10]) or for patients being treated with MTX who were also receiving glucocorticoids (0.87 per 1,000 person-years).

Patients being treated with glucocorticoids and NSAIDs together had a perforation risk of 4.7, compared to 2.8 for glucocorticoids alone.

In addition, 70% of patients with GI perforation received glucocorticoids, had antecedent diverticulitis, or both. The researchers found that diverticulitus was also a strong risk factor, with a hazard ratio of 9.1. “Because a majority of patients with GI perforation were being treated with glucocorticoids or had previously experienced diverticulitis, these individuals should be considered at higher risk,” wrote lead author Jeffrey R. Curtis, MD, MPH, with the University of Alabama, Tuscaloosa.