Sugimori Satoshi, Watanabe Toshio, Tabuchi Masahiko, Kameda Natsuhiko, Machida Hirohisa, Okazaki Hirotoshi, Tanigawa Tetsuya, Yamagami Hirokazu, Shiba Masatsugu, Watanabe Kenji, Tominaga Kazunari, Fujiwara Yasuhiro, Oshitani Nobuhide, Koike Tatsuya, Higuchi Kazuhide, Arakawa Tetsuo
Department of Gastroenterology, Osaka City University Graduate School of Medicine, Abeno-ku, Osaka, Japan.
Digestion. 2008;78(4):208-13. doi: 10.1159/000190403. Epub 2009 Jan 13.
The medical treatment of rheumatoid arthritis (RA) includes nonsteroidal anti-inflammatory drugs (NSAIDs), low-dose corticosteroids, and disease-modifying antirheumatic drugs (DMARDs). We evaluated the incidence of small bowel injury in RA patients who were taking anti-RA drugs with or without concomitant NSAIDs by capsule endoscopy.
A total of 28 RA patients who took low-dose corticosteroids and/or DMARDs for more than 1 year were enrolled.
The incidence of red spots did not differ between the 2 groups: 14 of 16 patients (87.5%) in the NSAID group and 11 of 12 patients (91.7%) in the non-NSAID group. In contrast, the incidence of mucosal breaks was significantly higher in the NSAID group than in the non-NSAID group: mucosal breaks were detected in 13 of 16 patients (81.3%) and 4 of 12 patients (33.3%) in the NSAID and non-NSAID groups, respectively. In the NSAID group, mucosal breaks developed in users of preferential cyclooxygenase-2 inhibitors at a frequency similar to that in users of traditional NSAIDs.
Patients taking anti-RA drugs may have an increased frequency of small bowel injury regardless of NSAID use, and NSAID use may be associated with an increased incidence of severe small bowel injury.
类风湿关节炎（RA）的药物治疗包括非甾体抗炎药（NSAIDs）、小剂量糖皮质激素和改善病情抗风湿药（DMARDs）。我们通过胶囊内镜评估了服用抗RA药物且伴或不伴有NSAIDs的RA患者小肠损伤的发生率。
共纳入28例服用小剂量糖皮质激素和/或DMARDs超过1年的RA患者。
两组红斑的发生率无差异：NSAID组16例患者中有14例（87.5%），非NSAID组12例患者中有11例（91.7%）。相比之下，NSAID组黏膜破损的发生率显著高于非NSAID组：NSAID组16例患者中有13例（81.3%）检测到黏膜破损，非NSAID组12例患者中有4例（33.3%）检测到黏膜破损。在NSAID组中，优先使用环氧化酶-2抑制剂的患者黏膜破损的发生率与使用传统NSAIDs的患者相似。
无论是否使用NSAIDs，服用抗RA药物的患者小肠损伤的发生率可能都会增加，且使用NSAIDs可能与严重小肠损伤的发生率增加有关。
