Peptic Ulcer and Rheumatoid Arthritis

Atwater, Edward C.

doi:10.1001/archinte.1965.03860140064013

Cited by 42 publications

(6 citation statements)

References 8 publications

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“…Enteric-coated preparations of prednisolone have been available for many years, although the evidence on which their use is based is purely subjective (West, 1959). Whether chronic therapy with prednisolone predisposes to gastric ulceration, particularly in patients with diseases other than rheumatoid arthritis (in whom there appears to be an increased incidence regardless of steroid therapy: Atwater, Morgan, Weihl & Jacox, 1965), has been disputed (Fenster, 1973;Conn & Blitzer, 1976). Although there is no evidence that prednisolone exerts a direct effect on the gastric mucosa (Smith, Mason & Oberhelman, 1968), there are some patients receiving long-term treatment who suffer from dyspepsia and who appear to gain some relief when their therapy is changed to an entericcoated preparation.…”

Section: Introductionmentioning

confidence: 99%

The effect of food and tablet formulation on plasma prednisolone levels following administration of enteric‐coated tablets.

Lee¹,

Taylor²,

Walker³

et al. 1979

Brit J Clinical Pharma

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1 Plasma prednisolone levels have been compared following the administration of enteric‐coated prednisolone to fasted and non‐fasted subjects. The effect on plasma levels of altering the formulation of the enteric‐coating has also been studied. 2 The presence of food in the stomach at the time of administration does not affect the absorption of enteric‐coated prednisolone tablets. 3 There was considerable inter‐subject variation in plasma prednisolone levels after administration of shellac based enteric‐coated tablets. However, plasma levels were more consistent when a preparation whose formulation was based upon cellulose acetate phthalate (CAP) was given. 4 It is concluded that the pattern of absorption and plasma prednisolone levels depend on the formulation of the enteric coating. The bioavailability of the CAP based preparation is similar to that of plain prednisolone.

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Section: Introductionmentioning

confidence: 99%

The effect of food and tablet formulation on plasma prednisolone levels following administration of enteric‐coated tablets.

Lee¹,

Taylor²,

Walker³

et al. 1979

Brit J Clinical Pharma

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“…As we have shown, well-matched controls are needed with regard to age and sex because of the differences in ulcer behaviour. Addition ally, there may be an inherent tendency to GU in rheumatoid disease [9,22,23] but, not surprisingly, there have been no controlled studies in the absence of treatment. Kurata et al [24] emphasized the statistical inadequacy of all published data.…”

Section: Discussionmentioning

confidence: 99%

Changing Clinical Pattern of Gastric Ulcer: Are Anti-Inflammatory Drugs Involved?

Jolobe¹,

Montgomery²

1984

Digestion

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The changing pattern of gastric ulcer (GU) has been studied in a series of 528 cases presenting in one hospital department during the past 20 years. The male:female ratio has declined and is now equal, and age-adjusted figures show that this applies to all age groups. There was a significant decline in mid-gastric ulcers in men. There was a 4-fold increased incidence of haemorrhage in proximal as opposed to antral ulcers and a 7-fold excess of haemorrhage in older women as opposed to younger women. GU in elderly women taking non-aspirin non-steroidal anti-inflammatory drugs (NANSADs) showed an increased tendency to bleeding, accounting for half of all haemorrhages in women over 70 years. However, on statistical analysis NANSAD-associated ulcers showed no other distinguishing features, and the use of NANSADs did not contribute significantly to the changing sex ratio. There is still no satisfactory evidence that these drugs play a causal role in chronic GU.

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“…The prevalence of peptic ulcer disease in a general population has varied from 2-3% to 10-19%, depending on the methods and criteria used to document the presence of peptic ulcer (13). In patients with rheumatoid arthritis, several studies have shown incidence rates of peptic ulcer disease between 20-30% (14,15). Bowen et a1 (16) examined the clinical records of 2,114 patients with rheumatoid arthritis and found the incidence of peptic ulceration in these patients was 3 to 4 times the incidence of peptic ulceration in the general population in that clinic.…”

Section: Discussionmentioning

confidence: 99%

Genetic predictors of patient response and side effects in the treatment of rheumatoid arthritis with a high dose nonsteroidal antiinflammatory drug regimen

Semble

Metcalf

Turner

et al. 1982

Arthritis & Rheumatism

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Clinical, laboratory, genetic, and radiologic studies were evaluated for 18 patients with rheumatoid arthritis who were treated for a mean of 16.6 months with a regimen involving supplementary aspirin and piroxicam, an investigational, nonsteroidal antiinflammatory agent. Although improvement in disease activity was seen, progression was evident on successive radiographs. Disease activity was not associated with the presence of any of the genetic markers. Peptic ulcers developed in 33% of patients, all of whom had type 0 blood. ABO blood typing may therefore be useful in patients with rheumatoid arthritis before consideration of therapy with potentially ulcerogenic drugs.In rheumatoid arthritis, recent evidence has suggested that the characterization of certain genetic factors, such as human leukocyte antigens (HLA), A 3 0 blood groups, and alpha-I-antitrypsin phenotypes, may be useful in predicting the severity of PATIENTS AND METHODSIn an open-label study, 45 patients, ages 21-65 years, with rheumatoid arthritis categorized as functional class I1 or 111 according to criteria of the American Rheumatism Association (4), took between 20 and 40 mg of piroxicam daily for up to 946 days (5). Patients with active ulcer disease were excluded by a preliminary upper gastrointestinal barium roentgenogram. Patients who developed gastrointestinal symptoms suggestive of ulcer disease underwent additional radiologic study. Maintenance doses of gold, prednisone (510 mg/day), and small doses of aspirin were allowed but carefully recorded. For 3 months, patients were evaluated with safety and articular checks every 2 weeks; thereafter, the checks were at monthly intervals. Patient and observer assessments, the latex agglutination test, grip strength, joint count, and the Westergren erythrocyte sedimentation rate comprised a cumulative grading method, the Modified Rheumatoid Activity Index (6). This index was calculated by expressing the raw scores of the 6 parameters as percentages, adding them together, and multiplying the sum by y6.The minimum score possible was 0, the maximum, 245 (6). Joint counts were graded 1 (subjective tenderness only), 2 (wincing), and 3 (wincing plus withdrawal) in 76 joints; the maximum possible score was 228.

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Peptic Ulcer and Rheumatoid Arthritis

Cited by 42 publications

References 8 publications

The effect of food and tablet formulation on plasma prednisolone levels following administration of enteric‐coated tablets.

The effect of food and tablet formulation on plasma prednisolone levels following administration of enteric‐coated tablets.

Changing Clinical Pattern of Gastric Ulcer: Are Anti-Inflammatory Drugs Involved?

Genetic predictors of patient response and side effects in the treatment of rheumatoid arthritis with a high dose nonsteroidal antiinflammatory drug regimen

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