Can Rheumatoid Arthritis Cause Gastrointestinal Issues?

Rheumatoid arthritis (RA) is a chronic, inflammatory disease that particularly affects the joints. However, it can also affect the gastrointestinal (GI) system producing symptoms such as nausea, indigestion, and abdominal pain.

Untreated RA may affect various GI organs including the mouth, throat, esophagus, stomach, small and large intestines, pancreas, and liver.

According to the Arthritis Foundation, people with RA are about 70percent more prone to develop GI problems than those without RA. 

This may occur due to:

• Smoking
  • Contributes to several disorders of the digestive system, such as heartburn, gastroesophageal reflux disease (GERD), peptic ulcers, and certain liver diseases.
• Stress
  • Can be a driving force for the earlier onset and disease progress activity by promoting a proinflammatory state in the body.
• Obesity
  • Additional weight can increase the risk of many health problems, including GI conditions; excess fat tissue releases cytokines—proteins that can cause or worsen inflammation.
• Use of medications
  • Disease-modifying antirheumatic drugs, nonsteroidal anti-inflammatory drugs, tumor necrosis factor inhibitors, and corticosteroids (prednisone) cause digestive troubles including pain, bloating, constipation, and diarrhea.
• Prior GI disease
  • Stomach conditions such as GERD and irritable bowel syndrome affect healthy individuals too.
• History of abdominal surgery
  • Abdominal surgical procedures for the liver, pancreas, and GI cancer can lead to complications such as decreased GI tract motility, wound dehiscence, or hernia.
• An increased risk of infection
  • Drugs used to treat RA may help calm overactive immune systems, but they can lower the body’s ability to fight infection, which results in bacterial infections such as diverticulitis or infectious colitis.
• Chronic inflammation in the body
  • People with RA may have other autoimmune coexisting diseases including inflammatory bowel disease, autoimmune hepatitis, and celiac disease, which can directly affect the GI tract.
• Untreated RA
  • RA also attacks other organs in the body including the lungs, eyes, and stomach. If RA is left untreated, about five percent of patients may develop a condition called rheumatoid vasculitis (inflammation and narrowing of blood vessels) that causes inflammation in the GI tract.

The most common signs and symptoms of rheumatoid arthritis (RA) include:

• Pain, swelling, and stiffness of the joints
• Joints are typically affected in a symmetrical pattern (both hands and feet are affected simultaneously)
• Joint pain and stiffness are worse in the morning or after a long period of rest

Additional symptoms of RA may include:

• Loss of energy
• Low-grade fever
• Weight loss
• Anemia (decreased red blood cells)
• Rheumatoid nodules (firm lumps of noncancerous tissue)

Unfortunately, there is no single test to diagnose rheumatoid arthritis (RA) in its early stages. A healthcare provider will examine the affected joint and may recommend certain tests:

• Blood tests: To check for
  • Anemia (low red blood cell count)
  • Rheumatoid factor, found in most people with RA
  • Inflammation (using erythrocyte sedimentation rate)
  • Antibodies to a chemical called cyclic citrullinated peptides
  • High levels of C-reactive protein
• Physical examination: To look for
  • Noticeable swelling
  • Redness and warmth
  • Reduced range of motion
  • Pain
  • Joint instability
• Imaging techniques: An X-ray of the affected joint may show
  • Bone spurs
  • Worn-down cartilage
  • Loss of joint space
• Other tests: An MRI or a CT scan may be required to determine the condition of the bone and soft tissues of the affected joint

The treatment of gastrointestinal complications of rheumatoid arthritis depends on the cause of the complications.

• Medications
  • Nonsteroidal anti-inflammatory drugs
    • Ibuprofen
    • Naproxen 
    • Aspirin
  • Disease-modifying antirheumatic drugs
    • Methotrexate
    • Tocilizumab
    • Cyclophosphamide
    • Rituximab
  • Glucocorticoids
    • Prednisone
• Lifestyle modifications
  • Try aerobic exercises
  • Eat right
  • Avoid stress

Other potential complications of rheumatoid arthritis include:

• Osteoporosis
• Rheumatoid nodules (tiny firm bumps that develop around the pressure areas)
• Dry eyes and mouth (a disorder characterized by a decrease in the amount of moisture in the eyes and mouth)
• Carpal tunnel syndrome (compression of the median nerve leading to numbness and tingling pain in the hand and forearm)
• Heart problems
• Lung disease
• Lymphoma (cancer in the lymph system)
• Felty’s syndrome (a triad of splenomegaly, neutropenia, and arthritis)