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Anti-tumor necrosis factor agents reduce NSAID-induced small bowel injury in rheumatoid arthritis

Anti-tumor necrosis factor agents reduce NSAID-induced small bowel injury in rheumatoid arthritis, reports the latest issue of Gut.

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The role of tumor necrosis factor α (TNFα) in the pathogenesis of non-steroidal anti-inflammatory drug (NSAID)-induced small intestinal damage remains unclear.

Dr Toshio Watanabe and colleagues from Japan evaluated the preventive effect of anti-TNF therapy against NSAID-induced enteropathy in rheumatoid arthritis patients.

Capsule endoscopy was performed in 95 consecutive rheumatoid arthritis patients who received NSAID for more than 3 months, with or without anti-TNF therapy over a period of 3 months.

The findings were scored from 0 to 4, with 0 being normal, 1 for red spots, 2 for 1 to 4 erosions, 3 for more than 4 erosions, and 4 being large erosions/ulcers.

The adjusted odds ratio for severe damage ranged from 0.23 to 0.26
Gut

The relationship between the use of anti-TNF therapy and the risk of severe damage or the most severe damage was assessed using multiple logistic regression analysis.

Furthermore, a propensity score matching analysis was performed to reduce the effects of TNF selection bias.

By stratifying the patients on the basis of anti-TNF therapy, the researchers obtained crude odds ratio of 0.23 for severe damage, and 0.37 for the most severe damage.

This protective effect of anti-TNF therapy remained robust to adjustments for baseline characteristics, with the adjusted odds ratio for severe damage and the most severe damage ranging from 0.23 to 0.26 and 0.06 to 0.41, respectively.

The team found that the propensity score matching yielded similar results and showed the protective effects of anti-TNF therapy against severe and most severe damage.

Dr Watanabe's team concludes, "Anti-TNF therapy may protect against NSAID-induced small intestinal damage in rheumatoid arthritis patients."

Gut 2014; 63: 409-414 
17 February 2014

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