Gastrointestinal disorders in rheumatic diseases

Abnormal exposure to bacterial or dietary antigen across a diseased bowel wall may result in extraintestinal clinical complaints. Persistence of this antigen for years at these extraintestinal sites does occur, resulting in chronic and sometimes autoreactive disease. Treating the bowel disease can "cure" the extraintestinal complaints, but identifying the etiology of the original bowel disorder remains a problem, especially with the inflammatory bowel diseases. In 1992, nonsteroidal anti-inflammatory drugs remain essential in the treatment of various rheumatologic complaints. Although these drugs do work, they also produce gastrointestinal disease that may be far more extensive than was formerly appreciated. This risk is obviously a problem, and those who demand a change in our therapeutic approach to arthritis probably have the right idea.