Jun 26, 2012

Factors associated with gastrointestinal perforation in a cohort of patients with rheumatoid arthritis

Arthritis Care & Research
Jeffrey R CurtisKathy L Schulman


To estimate the incidence and risk factors for gastrointestinal (GI) perforation among patients with rheumatoid arthritis (RA). Claims from employer health insurance plans were used to identify RA patients and those hospitalized for upper or lower GI perforation. GI perforation cases were identified using both a sensitive and a specific definition. A Cox model using fixed and time-varying covariates was used to evaluate the risk of GI perforation. Among 143,433 RA patients, and using a maximally sensitive GI perforation definition, 696 hospitalizations with perforation were identified. The rate of perforation was 1.70 per 1,000 person years (PYs; 95% confidence interval [95% CI] 1.58-1.83), and most perforations (83%) occurred in the lower GI tract. The rate of perforation was lower when a more specific GI perforation definition was used (0.87; 95% CI 0.78-0.96 per 1,000 PYs). Age and diverticulitis were among the strongest risk factors for perforation (diverticulitis hazard ratio [HR] 14.5 [95% CI 11.8-17.7] for the more sensitive definition, HR 3.9 [95% CI 2.5-5.9] for the more specific definition). Among various RA medication groups and compared to methotrexate, the risk of GI perforation was highest among patients with expo...Continue Reading

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Mentioned in this Paper

Antirheumatic Drugs, Disease-Modifying
Glucocorticoid inhalants for obstructive airway disease
Intestinal Perforation
Analgesics, Anti-Inflammatory
Anti-Inflammatory Agents, Non-Steroidal
Incidence Studies
Glucocorticoids, Systemic
Gastrointestinal Diseases
Rheumatoid Arthritis
Retinal Perforations

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