Nonsteroidal antiinflammatory drug-induced small intestinal inflammation and blood loss. Effects of sulfasalazine and other disease-modifying antirheumatic drugs

Arthritis Rheum. 1994 Aug;37(8):1146-50. doi: 10.1002/art.1780370806.


Objective: To identify the source of intestinal blood loss in rheumatoid arthritis patients being treated with nonsteroidal antiinflammatory drugs (NSAIDs) and assess the response to sulfasalazine and other disease-modifying antirheumatic drugs (DMARDs).

Methods: Intestinal inflammation, blood loss, and gastroduodenal damage, and the response to treatment with DMARDs, were assessed in 46 patients taking NSAIDs.

Results: Intestinal inflammation and blood loss correlated significantly with one another (r = 0.43, P < 0.003), but not with the macroscopic or microscopic appearance of the gastroduodenal mucosa. Sulfasalazine reduced both intestinal inflammation and blood loss, whereas the other DMARDs did not.

Conclusion: The small intestine is the main site of mild chronic blood loss in patients receiving NSAIDs, and this blood loss can be reduced with sulfasalazine treatment.

MeSH terms

  • Aged
  • Anti-Inflammatory Agents, Non-Steroidal / adverse effects*
  • Arthritis, Rheumatoid / drug therapy
  • Arthritis, Rheumatoid / physiopathology
  • Enteritis / chemically induced*
  • Female
  • Gastrointestinal Hemorrhage / chemically induced*
  • Humans
  • Indium Radioisotopes
  • Leukocytes
  • Male
  • Middle Aged
  • Sulfasalazine / pharmacology
  • Sulfasalazine / therapeutic use*


  • Anti-Inflammatory Agents, Non-Steroidal
  • Indium Radioisotopes
  • Sulfasalazine