Small intestinal injury in NSAID users suffering from rheumatoid arthritis or osteoarthritis

Rheumatol Int. 2016 Nov;36(11):1557-1561. doi: 10.1007/s00296-016-3552-x. Epub 2016 Aug 22.


The goal of this prospective study was to assess non-steroidal anti-inflammatory drug (NSAID)-induced enteropathy in patients with rheumatoid arthritis (RA) or osteoarthritis (OA) by means of non-invasive wireless capsule enteroscopy. A total of 143 patients (74 with RA, 69 with OA) treated with NSAIDs (>1 month) and 42 healthy volunteers were included. All subjects underwent capsule endoscopy, laboratory tests and filled in questionnaires. The severity of small bowel injury was graded as: mild (red spots or sporadic erosions), moderate (10-20 erosions) or severe (>20 erosions or ulcers). Capsule endoscopy identified small bowel lesions in 44.8 % of patients (mild 36.4 %, moderate 3.5 % and severe in 4.9 %). Mild non-specific lesions were found in 11.9 % healthy volunteers. There was a significantly higher prevalence of enteropathy in RA (56.8 %) compared to OA (31.9 %, p < 0.01). A significant difference between NSAID users (RA and OA) with and without enteropathy was observed in erythrocytes (p < 0.01), the leucocyte count (p < 0.05), haemoglobin (p < 0.05), haematocrit (p < 0.05), serum albumin (p < 0.01) and erythrocyte sedimentation rate (p < 0.05). No relationship was found between enteropathy and dyspepsia, gender or age. NSAID therapy is associated with a significant risk of small bowel injury. The risk is significantly higher in RA patients suggesting a possible influence of the underlying disease.

Trial registration number: DRKS00004940.

Keywords: Enteropathy; Non-steroidal anti-inflammatory drug; Osteoarthritis; Rheumatoid arthritis; Small bowel; Wireless capsule endoscopy.

MeSH terms

  • Adult
  • Anti-Inflammatory Agents, Non-Steroidal / adverse effects*
  • Anti-Inflammatory Agents, Non-Steroidal / therapeutic use
  • Arthritis, Rheumatoid / drug therapy*
  • Capsule Endoscopy
  • Female
  • Humans
  • Intestinal Diseases / chemically induced*
  • Intestinal Diseases / diagnostic imaging
  • Intestinal Diseases / epidemiology
  • Intestine, Small / diagnostic imaging*
  • Male
  • Middle Aged
  • Osteoarthritis / drug therapy*
  • Prevalence
  • Prospective Studies
  • Surveys and Questionnaires


  • Anti-Inflammatory Agents, Non-Steroidal

Associated data

  • DRKS/DRKS00004940