Title:Clinical and Morphological Evaluation of Erosive and Ulcerative Gastric
Lesions in Patients with Rheumatoid Arthritis
Volume: 18
Issue: 1
Author(s): Vladimir Beloglazov, Andrey Petrov, Vitalii Kaliberdenko, Kseniya Abramova and Kulanthaivel Shanmugaraj*
Affiliation:
- Department of Internal Medicine, V.I. Vernadsky Crimean Federal University, Simferopol, Russia
Keywords:
Rheumatoid arthritis, NSAIDs, NSAID gastropathies, erosion, ulceration, morphology, erosive-ulcerative lesions.
Abstract:
Background: One of the most important problems associated with the treatment of
Rheumatoid Arthritis (RA) is erosive-ulcerative lesions (EUL) of the gastroduodenal zone, which is
associated with the use of non-steroidal anti-inflammatory drugs (NSAIDs).
Aims: Our research aims to study the clinical and histo-morphological criteria for forming the EUL
of the gastroduodenal zone in patients with RA.
Methods: Patients were divided into 3 groups, depending on the presence of an EUL, according to
Fibrogastroduodenoscopy (FGDS) data with a negative test for H. pylori. Group 1 included RA
patients without EUL (n = 18), group 2 RA patients with erosive lesions of the gastroduodenal zone
(n = 57), and group 3 consisted of RA patients with ulcerative lesions (n = 17). As a norm, we used
data from a survey of 18 healthy donors corresponding to RA patient’s age and sex distribution,
where no somatic pathology was revealed. GSRS questionnaire was used for assessment of subjective
symptoms. For histomorphological studies, biopsy specimens were taken during FGDS using
an Olympus Evis Exera II digital video endoscope.
Results: Patients of RA with EUL in the gastro-duodenal zone were significantly different from the
group of healthy donors and patients of group 1 by the severity of 5 symptoms related to the upper
gastrointestinal tract according to the GSRS questionnaire, including abdominal pain, heartburn,
belching acid, a feeling of sucking and burning in epigastria, nausea and vomiting. In general, there
were no clinically significant differences between the frequency of occurrence and the severity of
symptoms on the GSRS scale between group 2 and group 3, except for complaints of heartburn. So,
RA patients of group 3 had a higher rate of heartburn feeling of 3.0 (2.0-3.0) points than patients of
group 2 with 2.0 (1.0-2.0) points.
Conclusion: The development of a EUL of the gastroduodenal zone in patients with RA is associated
with low activity of inflammation in all studied slides, regardless of structurally destructive
changes in the stomach and duodenum and compensatory hyperplastic reactions in the superficial
layer of mucosa membrane, which can be determined by minimal subjective sensations or even
complete absence of clinical manifestations with the formation of “silent ulcers”, complicated by
bleeding and perforation.
