Influence of Gastrointestinal Symptoms on Patient Global Assessment in Patients with Rheumatoid Arthritis

This study aimed to determine the influence of gastrointestinal (GI) symptoms on patient global assessment (PGA) in patients with rheumatoid arthritis (RA). This cross-sectional study examined 837 patients with RA treated in our department between April 1 and September 30, 2017. GI symptoms were evaluated by the Gastrointestinal Symptom Rating Scale, wherein a score of ≥ 2 was considered “symptomatic.” PGA and proportion of PGA ≤ 1 were compared between symptomatic and asymptomatic patients. Factors associated with achievement of PGA ≤ 1 were assessed with logistic regression models. Of our study population, 28%, 24%, 28%, 28%, and 45% had reflux, abdominal pain, indigestion, diarrhea, and constipation, respectively, and 64% had at least one GI symptom. The symptomatic group had a significantly higher PGA score than the asymptomatic group in all GI symptoms (P < 0.001 for all comparisons). The proportion of patients with a PGA ≤ 1 in the symptomatic group was significantly lower than that in the asymptomatic group for reflux (20% vs. 37%), abdominal pain (21% vs. 36%), indigestion (18% vs. 38%), diarrhea (18% vs. 38%), and constipation (24% vs. 39%) (P < 0.001 for all comparisons). All GI symptoms were significantly associated with achievement of PGA ≤ 1 in patients without significant joint inflammation; this association was not observed for reflux and abdominal pain in patients with significant joint inflammation. GI symptoms can be one of the drivers of PGA in patients with RA, particularly in those without significant joint inflammation.