Pathogenesis of peptic ulcer in rheumatoid arthritis

To assess the pathogenesis of the gastro-duodenal mucosal lesions in rheumatoid arthritis, 36 patients, consisting of 23 (group I) receiving non-steroidal anti-inflammatory drugs (NSAIDs) and 13 (group II) on alternative forms of treatment, were examined by fibreoptic upper gastrointestinal endoscopy. Ten (43%) of 23 patients receiving NSAIDs showed mucosal damage in the form of erosions or a definite ulcer crater, compared to only one (8%) of 13 in group II (p less than 0.05). There was no correlation between the duration of illness and the incidence of mucosal lesions. These findings indicate that the high incidence of gastroduodenal mucosal abnormalities seen in rheumatoid arthritis is related to the use of NSAIDs and not to the underlying disease process.