Gastrointestinal problems in arthritis

by Dr. Sheetal Mahajani

Arthritis is a chronic ailment of joints. It generally affects elderly population, some can start early in life. When one says so, naturally with aging, certain movement slow down plus the disease reduces / restricts certain daily activities. Here then starts discrepancy between the food intake and its due metabolism. Slowing of movements may slow down activity of large intestine and one can conclude that the digestion is improper. Which is a very usual complaint.

Also as is the general thinking of society the allopathic medicines are strong on our digestion. This may be more evidently mentioned about arthritis medicines.

Now let us scientifically see whether arthritis / its medicines affects the gastrointestinal system / or in short the digestion.

Scientifically the problems can be divided into

• Medicines side effects
• Disease-related gastrointestinal (GI) involvement

Arthritis & GI Involvement

• Certain seronegative spondylo arthropathy have involvement of colon / large intestine. example - Ulcerative colitis Crohn's disease.
• Drug related
  i. NSA IDS
  ii. DMARDS
  iii. Biologic agents

Arthritis and GI involvement

Small subgroup of arthritis patients especiallythose under seronegative spondyloarthropathy have specific involvement of gastrointestinal system (GI) The Gl involvement may be subcategorised into ulcerative colitis or Crohn's disease. These diseases affect small and large intestine. Ulcerative colitis may be symptomatically identified by increased frequency of motions, passing blood and mucus in stools, urgency for passing stools, night frequency etc. Crohn's disease also has similar presentation. Pain may be predominant feature. Some patients who develop stricture because of Crohn's disease can have vomiting or abdominal distension. Both these disorders need attention of a gastroenterologist and specific investigations like endoscopies and other radio logical imaging like barium studies etc.

These diseases can be treated with saminosalisylic acid compound, steroids or other immunosupresants such as azathioprine, cyclosporine etc under strict medical guidance .

Drug induced GI Problems

Drugs or treatment of arthritis is obviously over a prolonged period of time. More over different groups of medicines are used for treating arthritis. Whether one likes or not some of the medicines have Gl side effects. It is therefore essential to know what are they and how to combat them. The benefits of the treatment of arthritis surely outweigh the Gl side effects, therefore before opening up the topic I must advise arthritis patients not to stop treatment, recognise them early and seek expert medical opinion for the same.

Before going into the details of the side effects,let us first understand the commonly used groups of medicines for arthritis.

• NSAIDs - Nonsteroidal anti inflammatory drugs (Conventional)
• (DMARD) - Disease modifying anti rheumatiod drugs.
• Biological response modifiers.
• Targeted molecules.

Problems of NSAIDs

NSAIDs are divided into three subgroups as follows -

• Nonsalicylates - Diclofenac, Fenoprofen,Ibuprofen, Indomethacin, Ketoprofen, Mefenamic acid, Neloxicam, Maproxen, Piroxicam
• Salicylates - Aspirin.
• Cox 2 Inhibitors - Colecoxib, Rofecoxib,Etoricoxib, Parecoxib
Nonsalicylates and salicylates are more toxic to GI tract than the cox -2 inhibitors. NSAIDs can cause problems from oesophagus, stomach till large intestine. Oesophageal symptoms vary from heart burn, abdominal pain, mouth brash, vomiting. Small and large intestinal involvement may be in the form of loose motions, abdominal crampy pain.

Treatment of these problems -


• H2 Receptor antagonists ranitidine, famotidine.
• PPI - omeprazole, panto prazole.
• Prostaglandins - mesopro stol.
Most of the times the treating doctor for arthritis includes these medicines as preventive measures for GI problems. One needs to remember the symptoms and consult the treating doctor and if required seek professional help for the same.

Problems of DMARD

Drugs in this category are methtrexate,sulfasalazine, hydroxychloroquine, leflunomide.

These drugs are known to increase acidity problems. They can cause heart burns, upper abdominal pain etc.

Associated use of antiacidity drugs generally reduce the problem.

Diet in rheumatoid arthritis

The diet is very important especially to combat the GI side effects of the arthritis treatment.

Mainstay of the diet is distribution of diet through out the day. In general one should eat like a king at breakfast, common man at lunch time and like a poor man at dinner time.

Excess tea, coffee, aerated drinks, alcoholic beverages, smoking, bakery products, chocolate, extremely spicy, sour food should be avoided.

The diet should leave good combination of carbohydrates, proteins, facts. General principle of diet planning is it should not have excess calories, so as to, increase the weight. Often arthritis restricts ones activities and there is tending towards increase in weight.