A history of diverticulitis, along with age, and glucocorticoid or nonsteroidal anti-inflammatory drug use, increased the risk for gastrointestinal perforations in patients with rheumatoid arthritis, according to recent study results.
Using data from health insurance claims from Jan. 1, 2001, to June 30, 2009, researchers identified 143,433 patients with rheumatoid arthritis (RA). From that cohort, 696 patients were hospitalized with upper or lower gastrointestinal (GI) perforation. The mean age of the patients (72.7% women) with perforations was 57.7 years, and 42.2% of the patients were aged 65 years or older.
The overall incidence rate of GI perforation was 1.70 events per 1,000 person years (PY) (95% CI, 1.58-1.83) when researchers used a maximally sensitive definition for GI perforation. They also used a more specific definition and the rate was lower (0.87/1,000 PY; 95% CI, 0.78-0.96). Perforations occurred most frequently (83%) in the lower GI tract, and were associated with diverticulitis and appendicitis. Upper GI tract events were largely associated with gastric and duodenal ulcers.
Jeffrey R. Curtis
Risk for GI perforation was evaluated through a Cox model, using fixed and time-varying covariates. Results using the sensitive definition showed that patients with a history of diverticulitis (HR=14.5; 95% CI, 11.8-17.7) were at the greatest risk for GI perforation. Use of glucocorticoids (HR=2.2; 95% CI, 1.6-3.1), nonsteroidal anti-inflammatory drugs (HR=1.4; 95% CI, 1.2-1.6), increasing age (age ≥65, HR=2.1; 95% CI, 1.4-3.1) and higher levels of comorbidity also were clinically significant factors.
“GI perforations are of increasing interest in RA, given that there are associations between perforation and some of our newer RA drugs, including tocilizumab and the JAK [inhibitor] drugs,” researcher Jeffrey R. Curtis, MD, MS, MPH, director of the University of Alabama at Birmingham Arthritis Clinical Interventional Program, told Healio.com. “But there are few if any good background rates to compare with to know how elevated the perforation rates of the newer drugs may be.”
Disclosure: See the study for a full list of relevant disclosures.