Are non-steroidal anti-inflammatory drugs associated with small intestinal injury?

This study assessed the association between non-steroidal anti-inflammatory drugs (NSAIDs) and small intestinal injury in patients with rheumatoid arthritis and osteoarthritis. The authors concluded that there was a higher rate of small intestinal injury in patients treated with NSAIDs.

Patients with rheumatoid arthritis (RA) and osteoarthritis (OA, a wearing down of the joint tissue) often experience pain caused by inflammation in their joints. Non-steroidal anti-inflammatory drugs (NSAIDs) are the most commonly prescribed form of pain relief for RA and OA. While they are effective at relieving pain they have also been associated with increased levels of enteropathy (small intestinal injuries). These include erosion, ulcers and lesions in the small intestine.

Patients with enteropathy may experience pain and bleeding. It has been hard to diagnose in the past because the location of the lower intestine is difficult to examine. A new method has been developed where a patient can swallow a wireless capsule the size of a pill. The capsule has a camera attached to it and pictures are taken as it moves through the gastrointestinal tract. This is known as capsule endoscopy.

The current study made use of capsule endoscopy to examine the rates of enteropathy in patients with RA and OA.

143 patients with either RA or OA and 42 healthy volunteers were included in this study. All RA and OA patients were receiving treatment with NSAIDs for at least 1 month. All participants received a capsule endoscopy and their injuries were graded as mild, moderate or severe depending on the number of red spots, erosions and ulcers observed.

44.8% of RA and OA patients had small bowel lesions. 36.4% were mild, 3.5% were moderate and 4.9% were severe. 11.9% of the healthy volunteers were found to have mild lesions.

56.8% of RA patients had enteropathy compared to only 31.9% of OA patients.

The authors concluded NSAID treatment is associated with a significantly higher risk of small intestinal injury, particularly in RA patients.

The number of patients in this study is low and further investigation is needed to make final conclusions. The doses and frequency of NSAIDs taken varied between patients.

Consult with your physician if you have any concerns relating to your current treatment.