The Association between Gastrooesophageal Reflux Disease and Subsequent Rheumatoid Arthritis Occurrence

Background and Aims: Rheumatologic disorders (RDs) can manifest as gastrointestinal (GI) symptoms. Patients with systemic sclerosis (SSc) frequently experience upper GI symptoms due to a lack of esophageal contractility (AC). GORD (gastro oesophageal reflux disease) is a common comorbidity in rheumatoid arthritis patients (RA).The aim of the present study was to evaluate the correlation between manifestation of rheumatoid arthritis and gastrooesophageal reflux disease. Materials and Methods: This cross-sectional study was carried out on 845 gastro-oesophageal reflux disease patients who presented to department of medicine, Qazi Hussain Ahmad Medical Complex Nowshera and Lady Reading Hospital (LRH), Peshawar for period of six months i.e from January 2020 to June 2020. Consecutive patients with were premeditated subsequently taking written informed consent. Patients with prior history of Oesophageal surgery were excluded. The demographics characteristics such as age, BMI, gender, previous history, gastrointestinal symptoms severity, analgesics, and medication usage were recorded on a pre-designed questionnaire. Inflammatory marker’s results were taken in the forms of C - reactive protein (CRP), and Erythrocyte Sedimentation Rate (ESR). Ethical approval was taken from the respective institutional review board. SPSS version 20 was used for data analysis. Results: Out of 845 GORD patients, 110 (13%) had Rheumatologic disorders (mean age 49.5± 2.6 years, 71% females). The prevalence of rheumatoid arthritis (RA), systemic lupus erythematous (SLE), and the most common systemic sclerosis (SSc) were 39 (36%), 24 (21.8%), and 47 (42.2%) respectively. Regurgitation, dysphagia, heartburn, and nausea were the most severe symptoms of gastrointestinal patients having rheumatoid disorder. The GI symptoms had no significant association with SLE, RA, and SSc severity. Upper GI symptom severity did not differentiate between RDs. Conclusion: Our study concluded that subsequent rheumatoid arthritis has a significant association with gastro-oesophageal reflux disease. Keywords: Gastro-oesophagealReflux Disease, Rheumatoid arthritis, Systemic sclerosis

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The association between gastro-oesophageal reflux disease and subsequent rheumatoid arthritis occurrence: a nested case–control study from Taiwan

BMJ Open ◽

10.1136/bmjopen-2017-016667 ◽

2017 ◽

Vol 7 (11) ◽

pp. e016667 ◽

Cited By ~ 3

Author(s):

Herng-Ching Lin ◽

Sudha Xirasagar ◽

Cha-Ze Lee ◽

Chung-Chien Huang ◽

Chao-Hung Chen

Keyword(s):

Rheumatoid Arthritis ◽

Early Diagnosis ◽

Reflux Disease ◽

Treatment Guidelines ◽

Population Based ◽

Oesophageal Reflux ◽

Study Patient ◽

Oesophageal Reflux Disease ◽

Increased Risk

ObjectiveGastro-oesophageal reflux disease (GORD) is a common comorbidity among patients with rheumatoid arthritis (RA). While GORD has been attributed to the antirheumatic medications, no studies of human cohorts have investigated a link between GORD and RA. This study investigates whether GORD is associated with a subsequent RA diagnosis over a 5-year follow-up using a population-based dataset.SettingTaiwanParticipantsWe used data from the Taiwan Longitudinal Health Insurance Database. The study group consisted of 13 645 patients with an ambulatory claim showing a GORD diagnosis. We used propensity score matching to select 13 645 comparison patients (one per study patient with GORD).InterventionWe tracked each patient’s claims over a 5-year period to identify those who subsequently received a diagnosis of RA. Cox proportional hazard (PH) regression modelling was used for analysis.ResultsOver 5-year follow-up, RA incidence rate per 1000 person-years was 2.81 among patients with GORD and 0.84 among the comparison group. Cox PH modelling showed that GORD was independently associated with a 2.84-fold increased risk of RA (95% CI 2.09 to 3.85) over 5-year follow-up, after adjusting for the number of ambulatory care visits within the year following the index date (to mitigate surveillance bias).ConclusionsWe observed that GORD might associate with subsequent RA occurrence. Because current treatment guidelines for RA emphasise early diagnosis and prompt treatment, the observed association between GORD and RA may help acquaint clinicians to patients with GORD with higher RA risk and facilitate early diagnosis and treatment.

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