To determine the prevalence and stability of gastrointestinal (GI) symptoms in outpatients with rheumatoid arthritis (RA) and osteoarthritis (OA); to determine the specific symptoms that contribute to severity; and to determine the predictive value of GI symptoms and GI severity on the risk of future GI hospitalization.
A questionnaire survey was mailed to 1221 patients with RA and OA on a continuing 6 month schedule. Patients completed an average of 4.4 questionnaires (n = 5,047). Questionnaires included a visual analog scale GI severity scale, and questions regarding GI hospitalizations and specific GI symptoms. Hospitalizations that were reported as relating to the GI system were audited by checking hospital records.
We found 57.5%, 40.2%, and 25.5% of patients had at least one assessment in which they had a GI symptom severity of 0.25-0.99, 1.00-1.99, and 2.00 or greater, respectively. Overall 74.9% had at least one score of 0.25 or greater, and 73.6% had one score of < 0.25, the cutoff for GI symptoms. By contrast, 6.45% had a GI hospitalization, and in only 0.75% of the questionnaire assessments were hospitalizations noted. Pyrosis and peptic ulcer symptoms were common, and were found in 62.5% and 42.4% of patients and 28.2% and 12.9% of observations, respectively. Among patients reporting GI severity scores between 2 and 3, roughly 60% and 45% reported the presence of pyrosis and peptic ulcer symptoms, respectively. The presence of a GI severity score > or = 0.25 was associated with 2.8-3.0-fold increase in the risk of hospitalization over the following 6 months.
These data suggest that symptoms have an importance of their own that relates to quality of life, regardless of the risk of serious GI events like hospitalization, and that more attention should be placed on symptoms and symptom severity in future research. In spite of the statistical predictive value of GI symptom severity on future hospitalizations, it is important to recognize that rate of GI hospitalization increases from 0.92 per 100 patient-years to only 2.90 per 100 patient-years when the GI symptom scale goes from approximately zero to positive values. Thus, in spite of its statistical predictive ability, GI symptom severity is a poor clinical predictor of the hospitalizations that occur in patients with rheumatic diseases. Instead, GI symptom severity and specific GI symptoms have a separate importance to patients.