Rheumatoid arthritis (RA) is an autoimmune condition that mainly affects a person’s joints. However, RA can also cause symptoms that affect the gastrointestinal (GI) system, such as nausea, indigestion, and abdominal pain.
The GI system contains many different organs, including the:
- mouth
- throat
- esophagus, or food pipe
- stomach
- small and large intestines
- pancreas
- liver
- gallbladder
- spleen
This article discusses the effect of RA on the GI system, and the resulting symptoms. It also provides information on the relationship between GI problems and RA medication, as well as treatment options and prevention methods.
There are many important connections between the GI system and RA. Some
RA is an autoimmune disease. This means that it develops when a person’s immune system, whose role is to protect the body against disease, attacks healthy cells instead.
The primary symptom of RA is inflammation of the joints. However, RA
According to the Arthritis Foundation (AF), people with RA are approximately 70% more likely to develop GI problems than those without the condition.
This can occur for a variety of reasons, such as:
- A side effect of RA medications: Disease-modifying antirheumatic drugs (DMARDs), nonsteroidal anti-inflammatory drugs (NSAIDs), and corticosteroids can all produce symptoms such as constipation, pain, diarrhea, and bloating.
- Infection: DMARDs can lower the body’s ability to fight off infections. This can result in infectious colitis or diverticulitis to develop in the GI tract.
- Other autoimmune conditions: People with RA are
more likely to develop certain autoimmune diseases that can cause GI problems. Examples include inflammatory bowel disease (IBD), celiac disease, and autoimmune hepatitis. - A direct result of RA: Once RA has developed in a person’s body, it can cause other conditions that can result in GI problems, such as Felty’s syndrome, which can affect the liver. According to the AF, approximately 5% of those with RA will develop rheumatoid vasculitis (RV), which leads to inflammation in the GI tract.
Some RA medications can produce GI side effects. The AF notes that medications for RA are the most likely cause of GI symptoms.
A
NSAIDs
NSAIDs can help relieve pain and reduce inflammation. However, prolonged use can lead to the following:
| Effect on GI system | Resulting symptoms |
|---|---|
| ulcerations | • indigestion • nausea and vomiting • heartburn • loss of appetite • weight loss • abdominal pain |
| GI bleeding | • abdominal cramps • tarry or black stool • vomit resembling coffee grounds • blood in stool • red blood in vomit |
| colitis | • diarrhea • abdominal pain • frequent urge to empty the bowels |
| hepatotoxicity | • pain in the upper right abdomen • loss of appetite • nausea • vomiting • tea-colored urine |
DMARDs
DMARDs are a group of medications that help slow the progression of RA. However, they can cause the following GI symptoms:
| Drug | Resulting symptoms |
|---|---|
| methotrexate | • stomatitis, which is inflammation of the mouth • nausea • abdominal pain • hepatotoxicity • diarrhea |
| leflunomide | • nausea • abdominal pain • diarrhea • hepatotoxicity |
| hydroxychloroquine | • abdominal pain • nausea |
| sulfasalazine | • abdominal pain • nausea • vomiting • diarrhea • hepatotoxicity |
| azathioprine | • anorexia • nausea • vomiting • hepatotoxicity |
| Janus kinase inhibitors | • abdominal pain • nausea • vomiting • diarrhea • GI perforations |
DMARDs can also lower the body’s ability to fight off infections. As a result, bacterial infections, such as bacterial colitis and diverticulitis, can occur.
Bacterial infectious colitis can cause abdominal pain and diarrhea. Diverticulitis can lead to diarrhea, constipation, and abdominal pain on the lower left side.
Corticosteroids
Corticosteroids can help alleviate inflammation. However, they can also weaken the immune system. This
Among symptoms of oral thrush are:
- cracks at the corners of the mouth
- an unpleasant taste in the mouth
- mouth pain, such as sore gums
- difficulty drinking and eating
- loss of the ability to taste things
Corticosteroids can also result in ulcerations and visceral perforation, which is when a hole forms through the stomach, large bowel, or small intestine.
Visceral perforation can cause severe stomach pain, nausea, vomiting, chills, and fever.
Tumor necrosis factor inhibitors
Tumor necrosis factor (TNF) inhibitors aid in reducing inflammation. However, they can produce the following GI symptoms:
- abdominal pain
- nausea
- vomiting
- diarrhea
- oral ulcers
- gastritis, which is inflammation of the stomach lining
- hepatotoxicity
They can also cause bowel obstructions, which can result in:
- severe abdominal pain
- cramping
- vomiting
- constipation
- inability to pass gas
- feelings of fullness or swelling in the stomach
Bowel perforations can also occur, which can lead to the following:
- severe abdominal pain
- fever
- chills
- abdominal swelling and bloating
- nausea
- vomiting
According to
Below, we outline these conditions along with their symptoms.
RV
In
RV is the inflammation and narrowing of the blood vessels. Although it typically affects the nerves, skin, fingers, and toes, it can also cause inflammation in the GI tract.
Among GI symptoms of RV are:
- weight loss
- loss of appetite
- abdominal pain
- diarrhea
- stomach ulcerations
- ulcers in the esophagus
- bowel perforation
- bloody stools
Other symptoms include:
- fever
- painful rashes, particularly on the legs
- numbness, tingling, and pain in the fingers and toes
- muscle weakness
- chest pain
Felty’s syndrome
In
- an enlarged liver
- varices, which are swollen or enlarged veins
- fluid buildup in the abdomen
People with RA are
These conditions include:
Autoimmune hepatitis
Symptoms of autoimmune hepatitis vary but can include:
- fatigue
- nausea
- vomiting
- weight loss
- abdominal pain
- dark-colored urine
- pale stools
- rashes
- joint pain
- amenorrhea, or absence of menstruation
IBD
Symptoms of IBD include:
- abdominal pain, cramps, and swelling
- bloody and recurring diarrhea
- weight loss
Celiac disease
Celiac disease can manifest in various ways, including:
- abdominal pain
- bloating
- indigestion
- constipation
Secondary Sjögren’s disease
Secondary Sjögren’s disease occurs
Up to
It can cause dry mouth, which could impede chewing or swallowing. It also causes enlarged parotid glands, which are the two salivary glands just in front of the ears that produce saliva to help with chewing and digestion.
AA amyloidosis
AA amyloidosis is another rare complication of RA, occurring in
It can affect the esophagus, stomach, intestines, liver, or gallbladder in people with RA.
Symptoms include:
- weight loss
- abdominal pain
- diarrhea
- gastroesophageal reflux disease (GERD)
- GI bleeding, which sometimes can be fatal
Medical treatment for GI complications of RA
However, some RA treatments can cause GI symptoms.
To help relieve mouth sores, a person can try a saltwater rinse or use a mouthwash that contains lidocaine.
Additionally, a healthcare professional may be able to prescribe anti-nausea medication to help reduce feelings of nausea.
A person can discuss ways to reduce GI symptoms with a rheumatologist.
Certain GI symptoms may be harder to treat than others. For instance, because RV is a rare complication of RA, scientists have not collected much quality evidence about effective treatments.
A person with RA may also be able to relieve certain GI symptoms, such as nausea and dry mouth, without using medications. A doctor can advise them about safe home remedies to address such symptoms.
Moreover, physiological health conditions can negatively impact a person’s psychological well-being. Some people with RA might therefore benefit from attending to their mental well-being by:
- receiving therapy
- engaging in relaxing and gentle forms of exercise
- practicing meditation
RA and the various GI symptoms it can cause arise from a complicated mix of biological and environmental factors.
A person may not be able to prevent some GI symptoms. However, their diet can help improve some RA symptoms.
Learn more about what foods to eat and avoid for RA here.
Individuals can also try taking folic acid to prevent some side effects that occur as a result of RA medication.
Some healthcare professionals may recommend taking 1 milligram (mg) of folic acid per day. Others may suggest taking 5 mg of folic acid per week in a single dose.
Anyone with GI symptoms should promptly seek guidance from a doctor.
The same is true for other symptoms of RA,
- stiffness in the joints
- joint pain or tenderness
- joint swelling
- joint deformities, especially in the fingers
- decreased range of motion
- rheumatoid nodules
It is also important for people taking RA medications to look out for any GI side effects.
RA is a common condition that affects the joints. However, there is a strong connection between RA and the GI system. That is why RA can also lead to GI problems.
Although these symptoms can be difficult to manage, treatment options are available. A person should seek guidance from a healthcare professional to help them find the most suitable treatment.