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. 2024 Jun 30;35(2):210-219.
doi: 10.31138/mjr.230324.pca. eCollection 2024 Jun.

Prevalence, Causes and Outcomes of Acute Gastrointestinal Bleeding in Rheumatoid Arthritis: A Systematic Review and Meta-Analysis

Shobhit Piplani  1 , Vladimir Jelic  1 , Adejoke Johnson  1 , Usman Shah  1 , Shiny Kolli  1 , Steve Kong  1 , Nikola Tanasijevic  1 , Vishal Reddy Bejugam  1 , Sumaja Reddy Goguri  2 , Phanidhar Mogga  2 , Sripada Preetham Kasire  1 , Salil Chaturvedi  1 , Priyanshu Jain  3
Affiliations

Prevalence, Causes and Outcomes of Acute Gastrointestinal Bleeding in Rheumatoid Arthritis: A Systematic Review and Meta-Analysis

Shobhit Piplani et al. Mediterr J Rheumatol. .

Abstract

Aim: The present study aims to investigate the prevalence, causes and outcomes of acute gastrointestinal (GI) bleeding in Rheumatoid arthritis (RA).

Methods: A systemic search was conducted from electronic databases (PubMed/Medline, Cochrane Library, and Google Scholar) from inception to 14th November 2023. All statistical analyses were conducted in Review Manager 5.4.1. Studies meeting inclusion criteria were selected. A random-effect model was used when heterogeneity was seen to pool the studies, and the result was reported in prevalence and their corresponding 95% confidence interval (CI). Other outcomes were assessed using qualitative analysis.

Results: A total of eight studies (six observational studies and 2 trials were used to conduct this systematic review and meta-analysis. A total population of 138,041 patients was used. Pooled analysis showed a statistically significant risk of GI bleeding in RA patients receiving NSAIDs (prevalence = 2% (1%, 3%); P < 0.00001; I2 = 98%). Qualitatively, causes and outcomes were discussed.

Conclusion: Our study showed that 2% RA patients were subjected to GI bleeding, when they used NSAIDs. Other causes of GI bleeding were age-related factors, cardiovascular events, history of GI complications, and peptic ulcers. Outcome varied by the use of specific NSAIDs and the presence of comorbidities. Recent guidelines for the management of RA may mention GI bleeding as a potential complication, but the level of emphasis placed on this issue varies. Some guidelines provide comprehensive recommendations for its prevention and management, while others offer limited guidance.

Keywords: NSAIDs; autoimmune; gastrointestinal bleeding; prednisone; rheumatoid arthritis.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1.
Figure 1.
PRISMA flow diagram.
Figure 2.
Figure 2.
Prevalence of gastrointestinal bleeding in rheumatoid arthritis.
See this image and copyright information in PMC

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