Piplani Shobhit, Jelic Vladimir, Johnson Adejoke, Shah Usman, Kolli Shiny, Kong Steve, Tanasijevic Nikola, Bejugam Vishal Reddy, Goguri Sumaja Reddy, Mogga Phanidhar, Kasire Sripada Preetham, Chaturvedi Salil, Jain Priyanshu
Jacobi Medical Centre/North Central Bronx, Albert Einstein College of Medicine, NYC Health and Hospitals, New York, New York, United States.
Frank H. Netter MD School of Medicine/St. Vincent's Medical Centre, Connecticut, United States.
Mediterr J Rheumatol. 2024 Jun 30;35(2):210-219. doi: 10.31138/mjr.230324.pca. eCollection 2024 Jun.
The present study aims to investigate the prevalence, causes and outcomes of acute gastrointestinal (GI) bleeding in Rheumatoid arthritis (RA).
A systemic search was conducted from electronic databases (PubMed/Medline, Cochrane Library, and Google Scholar) from inception to 14 November 2023. All statistical analyses were conducted in Review Manager 5.4.1. Studies meeting inclusion criteria were selected. A random-effect model was used when heterogeneity was seen to pool the studies, and the result was reported in prevalence and their corresponding 95% confidence interval (CI). Other outcomes were assessed using qualitative analysis.
A total of eight studies (six observational studies and 2 trials were used to conduct this systematic review and meta-analysis. A total population of 138,041 patients was used. Pooled analysis showed a statistically significant risk of GI bleeding in RA patients receiving NSAIDs (prevalence = 2% (1%, 3%); P < 0.00001; I2 = 98%). Qualitatively, causes and outcomes were discussed.
Our study showed that 2% RA patients were subjected to GI bleeding, when they used NSAIDs. Other causes of GI bleeding were age-related factors, cardiovascular events, history of GI complications, and peptic ulcers. Outcome varied by the use of specific NSAIDs and the presence of comorbidities. Recent guidelines for the management of RA may mention GI bleeding as a potential complication, but the level of emphasis placed on this issue varies. Some guidelines provide comprehensive recommendations for its prevention and management, while others offer limited guidance.
本研究旨在调查类风湿关节炎（RA）患者急性胃肠道（GI）出血的患病率、病因及预后。
从电子数据库（PubMed/Medline、Cochrane图书馆和谷歌学术）自创建至2023年11月14日进行系统检索。所有统计分析均在Review Manager 5.4.1中进行。选取符合纳入标准的研究。当存在异质性时，采用随机效应模型对研究进行汇总，并以患病率及其相应的95%置信区间（CI）报告结果。其他结局采用定性分析进行评估。
共八项研究（六项观察性研究和两项试验）用于本系统评价和荟萃分析。共纳入138,041例患者。汇总分析显示，接受非甾体抗炎药（NSAIDs）的RA患者发生胃肠道出血的风险具有统计学意义（患病率=2%（1%，3%）；P<0.00001；I²=98%）。定性地讨论了病因和预后。
我们的研究表明，2%的RA患者在使用NSAIDs时会发生胃肠道出血。胃肠道出血的其他原因包括年龄相关因素、心血管事件、胃肠道并发症史和消化性溃疡。预后因使用特定NSAIDs和合并症的存在而有所不同。近期RA管理指南可能提及胃肠道出血为潜在并发症，但对该问题的重视程度各不相同。一些指南提供了关于其预防和管理的全面建议，而其他指南提供的指导有限。
