The following is a summary of “Frequency of Helicobacter pylori in Patients With Rheumatoid Arthritis Whose Methotrexate Was Stopped Due to Gastrointestinal Intolerance,” published in the March 2023 issue of Rheumatology by Guloksuz, et al.

For a study, researchers sought to compare the frequency of Helicobacter pylori infection among patients with rheumatoid arthritis (RA) who experienced methotrexate (MTX)-related gastrointestinal system (GIS) intolerance and those without intolerance; second, to identify factors associated with MTX-related GIS intolerance.

The study analyzed data from 9,756 patients with RA who sought medical care between January 2011 and December 2020. MTX-related GIS intolerance was defined as the discontinuation of MTX due to dyspeptic symptoms despite supportive measures, and it was observed in 1,742 (31.3%) out of 5,572 MTX users. A total of 390 patients who underwent at least one gastroscopic evaluation were included in the final analysis. The demographic, clinical, laboratory, and pathologic characteristics of patients with and without MTX-related GIS intolerance were compared. Logistic regression analysis determined the factors associated with MTX-related GIS intolerance.

Among the 390 patients, 160 (41.0%) experienced MTX-related GIS intolerance. According to pathology results, the presence of H. pylori, inflammation, and activity was significantly higher in patients with MTX-related GIS intolerance (P < 0.001 for each comparison). In the multivariable logistic regression analysis, the use of biologic disease-modifying antirheumatic drugs (DMARDs) or targeted synthetic DMARDs, along with the presence of H. pylori, were identified as independently associated factors for MTX-related GIS intolerance (odds ratio [OR]: 3.03 for model 1; OR: 3.02 for model 2 for biologic/targeted synthetic DMARDs; OR: 9.13 for model 1; OR: 5.71 for model 2 for H. pylori presence).

The study revealed that the presence of H. pylori and the use of biologic or targeted synthetic DMARDs were associated with MTX-related GIS intolerance in patients with RA.