J Rheum Dis.  2016 Feb;23(1):47-54. 10.4078/jrd.2016.23.1.47.

Gastrointestinal Risk Factors and Non-steroidal Anti-inflammatory Drugs Use in Rheumatoid Arthritis and Osteoarthritis Patients in Korea

• Lee EY
• Hong SJ
• Park YB
• Park KS
• Choi CB
• Lee CK
• Song R
• Lee YJ
• Suh CH
• Kim HA
• Min JK
• Yoon CH
• Park W
• Chung WT
• Kim GT
• Choe JY
• Kang SW
• Park YW
• Yoo WH
• Lee SH

• KMID: 2222800
• DOI: http://doi.org/10.4078/jrd.2016.23.1.47

Abstract

OBJECTIVE
The aim of this study was to examine and compare the gastrointestinal (GI) risk factors and treatment patterns of rheumatoid arthritis (RA) and osteoarthritis (OA) patients in Korea.
METHODS
This was a cross-sectional, observational study on RA and OA patients taking non-steroidal anti-inflammatory drugs (NSAIDs) for at least 1 month. A total of 1,896 patients (981 RA patients, 915 OA patients) were recruited from 20 university hospitals. Data were collected through medical records and patient surveys. GI risk factors included age, prolonged (over 3 months) or high-dose use of NSAIDs, alcohol drinking, smoking, use of aspirin, anticoagulants or glucocorticoids, comorbidities, and history of Helicobacter pylori infection or other GI complications. Treatment patterns were classified according to groups using, selective cyclooxygenase (COX)-2 inhibitors+/-gastro-protective agents, non-selective COX-2 inhibitors+proton pump inhibitor, or non-selective COX-2 inhibitors+/-other gastro-protective agents.
RESULTS
GI risk factors were highly present in both RA and OA patients. The proportion of prolonged use of NSAIDs, smoking, and glucocorticoid use were higher in RA patients (p<0.001). The proportion of comorbidities and use of aspirin were higher in OA patients (p<0.001). The remaining GI risk factors were present in similar proportions in both groups. Use of selective COX-2 inhibitors or gastro-protective agents was higher in RA patients.
CONCLUSION
Prolonged use of NSAIDs and concomitant glucocorticoid use were higher in RA patients, while comorbidities and concomitant aspirin use were predominant in OA patients. These results will provide insights for use in development of future guidelines for proper selection of NSAIDs and effective prevention of GI complications in arthritis patients.

Keyword

Rheumatoid arthritis; Osteoarthritis; Gastrointestinal risk factors; Non-steroidal anti-inflammatory agents

MeSH Terms

Alcohol Drinking
Anti-Inflammatory Agents, Non-Steroidal
Anticoagulants
Arthritis
Arthritis, Rheumatoid*
Aspirin
Comorbidity
Cyclooxygenase 2 Inhibitors
Glucocorticoids
Helicobacter pylori
Hospitals, University
Humans
Korea*
Medical Records
Observational Study
Osteoarthritis*
Prostaglandin-Endoperoxide Synthases
Risk Factors*
Smoke
Smoking
Anti-Inflammatory Agents, Non-Steroidal
Anticoagulants
Aspirin
Cyclooxygenase 2 Inhibitors
Glucocorticoids
Prostaglandin-Endoperoxide Synthases
Smoke

Figure

• 

  Figure 1. Gastrointestinal (GI) risk factors in rheumatoid arthritis and osteoarthritis patients (A: all age, B: ＜60 yr, C: ≥60 yr). NSAID: non-steroidal anti-inflammatory drug. *p＜0.001 by chi-square test.

• 

  Figure 2. Gastrointestinal (GI) risk factors stratified by 10 years age in rheumatoid arthritis and osteoarthritis patients (A: Rheu-matoid arthritis, B: Osteoarthritis). NSAID: non-steroidal anti-inflammatory drug.

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  Figure 3. Treatment patterns of NSAIDs by age. Values are presented as percent only. COX-2i: selective cycloxygenase-2 inhibitor, ns-NSAID: non-selective non-steroidal antiinflammatory drug, PPI: proton pump inhibitor. a vs. c, p＜0.001; b vs. d, p=0.270.

• 

  Figure 4. Treatment patterns in terms of gastrointestinal risk factor numbers. Values are presented as percent only. COX-2i: selective cycloxygenase-2 inhibitor, ns-NSAID: non-selective non-steroidal anti-inflammatory drug, PPI: proton pump inhibitor. a vs. d, p=0.046; b vs. e, p＜0.001; c vs. f, p=0.589.

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