Rheumatoid Arthritis and Your Digestive System

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If you're living with rheumatoid arthritis (RA), you may be familiar with symptoms of joint pain and stiffness. You may also be experiencing gastrointestinal (GI) symptoms. Many studies show that GI symptoms are common when you have RA. Your GI system has an upper and lower section, and RA can affect both of them. The upper GI system runs from your mouth, to where your stomach empties into your small intestine. The lower GI system is all of your small and large intestines.

A study published in the Journal of Rheumatology followed 813 people with RA and 813 people without RA for about 10 years. Those with RA had a 70% greater chance of having an upper GI problem and a 50% greater chance of having a lower GI problem, compared to people who didn't have RA.

Symptoms of Upper and Lower GI Problems

A study published in the journal Gastroenterology Research and Practice compared 284 people with RA to 233 people without RA, asking all of them to answer questions about upper and lower GI symptoms. The study found that upper GI symptoms like stomach pain, feeling full after meals, and nausea were more common in people with RA than people without RA. They also found that people with RA took more laxatives and more proton pump inhibitors, which are drugs that blocks stomach acid.

Here are some of the GI problems you may have with RA:

  • An ulcer or perforation (hole) in your stomach, small intestine, or large intestine

  • Swelling of your esophagus (swallowing tube)

  • Infection and swelling of your small or large intestine

These problems can produce symptoms that include:

  • Trouble swallowing

  • Heartburn

  • Belly pain

  • Indigestion

  • Black, tarry stools (due to upper GI bleeding)

  • Constipation

  • Bloody stools (due to lower GI bleeding)

  • Leaking of stool

What Causes GI Problems With RA

Some GI problems may be caused by the medications you take to control RA symptoms, especially nonsteroidal anti-inflammatory drugs (NSAIDs) and steroids.

Another possibility is that GI symptoms are actually part of RA. Although the exact cause of RA is not known, it is an autoimmune disease. That means that your immune system—your body’s defense system—attacks your joints by mistake, causing inflammation. It could be that your immune system is also causing inflammation in your GI system. More research is needed to fully understand the role of the immune system in GI symptoms.

What You Can Do About GI Symptoms

It's important to be aware of GI symptoms and let your doctor know about them, especially if you have signs of upper or lower GI bleeding. Follow your doctor's recommendations for relief. Not smoking, limiting steroid medications, limiting NSAIDs, and taking proton pump inhibitors may help reduce some symptoms.

You may also be able to lower your risk for GI symptoms by being careful about your diet. Some studies suggest that people with RA may be more likely to have food allergies. If you find that certain foods cause GI symptoms or make your other RA symptoms worse, talk to your doctor about eliminating these foods from your diet.

Although no diet can cure RA, you might be able to reduce RA symptoms and GI symptoms by sticking to a healthy anti-inflammatory diet. Here’s how it works:

  • Get lots of healthy fiber from fruits, vegetables, and whole grains. These sources of fiber have been shown to reduce inflammation.

  • Get protein from low-fat sources like lean meat and fat-free dairy products.

  • Eat coldwater fish for a source of protein one or two times a week. Fish like herring, mackerel, tuna, and salmon have omega-3 fatty acids that can help reduce inflammation.

  • Use olive oil for cooking and for salads. Olive oil reduces inflammation.

  • Make sure you're getting sufficient amounts of vitamin D, which is good for your immune system. Look for foods that are fortified with vitamin D, or take a vitamin D supplement if you can't sit in the sun for a few minutes every day.

Always check with your doctor before taking any large doses of dietary supplements or vitamins and before making any big changes in your diet. If you have GI symptoms along with your RA, let your doctor know. Working closely with your doctor is the best way to get these symptoms under control.

Key Takeaways

  • Studies show that both upper and lower GI problems are more common with RA.

  • Causes of GI symptoms may include RA medications and an inflammatory reaction that is part of the disease itself.

  • Be aware of GI symptoms and let your doctor know if you experience them.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2021 Jul 24
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THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
  1. Nutrition Guidelines for People With Rheumatoid Arthritis. Arthritis Foundation. http://www.arthritis.org/living-with-arthritis/arthritis-diet/anti-inflammatory/rheumatoid-arthritis...
  2. Gastrointestinal Problems in Rheumatoid Arthritis. Arthritis Foundation.http://www.arthritis.org/about-arthritis/types/rheumatoid-arthritis/articles/gastrointestinal-proble...
  3. Foods to Avoid If You Have Arthritis. Arthritis Foundation. http://www.arthritis.org/living-with-arthritis/arthritis-diet/foods-to-avoid-limit/
  4. Myasoedova E, et al. Prevalence and Risk Factors of Gastrointestinal Disorders in Patients with Rheumatoid Arthritis: Results from a Population-Based Survey in Olmstead County, Minnesota. Gastroenterology Research and Practice. 2011; 2011: 745829.