ASSOCIATION OF HELICOBACTER PYLORI INFECTION WITH METHOTREXATE-INDUCED GASTROINTESTINAL INTOLERANCE IN RHEUMATOID ARTHRITIS: A PROSPECTIVE STUDY USING H. PYLORI STOOL ANTIGEN TEST
Main Article Content
Keywords
Rheumatoid arthritis, Methotrexate, Helicobacter pylori, gastrointestinal intolerance, H. pylori eradication, Stool antigen test
Abstract
Background: Rheumatoid arthritis (RA) is a chronic disorder. It affects joints, causing pain and disability. Methotrexate (MTX) is a key treatment for RA. It reduces disease activity and slows progression. Yet, MTX often leads to gastrointestinal (GI) intolerance. This side effect affects patient compliance. Helicobacter pylorus (H. pylori) is a common GI pathogen. It is linked to various GI disorders, like peptic ulcers and gastritis. The high prevalence of H. pylori in Pakistan raises concerns. It may worsen GI side effects in RA patients on MTX therapy.
Objective: This study aimed to investigate the prevalence of H. pylori among RA patients on MTX and its link to MTX-induced GI intolerance.
Methods: A prospective observational cohort study was conducted at the Department of Rheumatology, Lady Reading Hospital, Peshawar, from October 2023 to September 2024. We enrolled 384 RA patients on MTX therapy. The sample size was calculated using the WHO calculator, based on a 52% prevalence of H. pylori in Pakistan. Participants were screened for H. pylori using the stool antigen test. Those testing positive with GI symptoms received eradication therapy with antibiotics and proton pump inhibitors. The primary outcome was the prevalence of H. pylori infection and its correlation with MTX-induced GI intolerance. Data were analyzed using SPSS version 26.0, employing chi-square tests, t-tests, and logistic regression.
Results: Of the 384 participants, 200 (52.1%) tested positive for H. pylori. GI intolerance was observed in 160 participants (41.7%). There was a significantly higher prevalence among H. pylori-positive patients (56.0%) compared to H. pylori-negative patients (26.1%) (p < 0.05). Post-eradication therapy, GI intolerance resolved in 75.0% of treated patients. This was significantly higher than the 62.5% resolution in untreated patients (p < 0.05).
Conclusion: Our study shows a significant link between H. pylori infection and MTX-induced GI intolerance in RA patients. Routine H. pylori screening and eradication could reduce GI intolerance, improving patient adherence to MTX therapy and overall disease management.
Objective: This study aimed to investigate the prevalence of H. pylori among RA patients on MTX and its link to MTX-induced GI intolerance.
Methods: A prospective observational cohort study was conducted at the Department of Rheumatology, Lady Reading Hospital, Peshawar, from October 2023 to September 2024. We enrolled 384 RA patients on MTX therapy. The sample size was calculated using the WHO calculator, based on a 52% prevalence of H. pylori in Pakistan. Participants were screened for H. pylori using the stool antigen test. Those testing positive with GI symptoms received eradication therapy with antibiotics and proton pump inhibitors. The primary outcome was the prevalence of H. pylori infection and its correlation with MTX-induced GI intolerance. Data were analyzed using SPSS version 26.0, employing chi-square tests, t-tests, and logistic regression.
Results: Of the 384 participants, 200 (52.1%) tested positive for H. pylori. GI intolerance was observed in 160 participants (41.7%). There was a significantly higher prevalence among H. pylori-positive patients (56.0%) compared to H. pylori-negative patients (26.1%) (p < 0.05). Post-eradication therapy, GI intolerance resolved in 75.0% of treated patients. This was significantly higher than the 62.5% resolution in untreated patients (p < 0.05).
Conclusion: Our study shows a significant link between H. pylori infection and MTX-induced GI intolerance in RA patients. Routine H. pylori screening and eradication could reduce GI intolerance, improving patient adherence to MTX therapy and overall disease management.
References
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2. Singh JA, Saag KG, Bridges SL Jr, et al. 2015 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis. Arthritis Rheumatol. 2016;68(1):1-26.
3. Kremer JM. Methotrexate and emerging therapies in rheumatoid arthritis. Rheumatology (Oxford). 2020;59(Suppl 1).
4. Hooi JKY, Lai WY, Ng WK, et al. Global Prevalence of Helicobacter pylori Infection: Systematic Review and Meta-Analysis. Gastroenterology. 2017;153(2):420-429.
5. Graham DY. Helicobacter pylori update: gastric cancer, reliable therapy, and possible benefits. Gastroenterology. 2015;148(4):719-31.
6. Fatima S, Ullah I, Ayaz M, et al. Prevalence and antibiotic susceptibility pattern of helicobacter pylori isolates from gastric biopsies of patients in tertiary care hospital. BiolClinSci Res J. 2024; doi:10.54112/bcsrj.v2024i1.682.
7. Figueiredo C, Machado JC, Yamaoka Y. Pathogenesis of Helicobacter pylori infection. Helicobacter. 2005;10 Suppl 1:14-20.
8. Talley NJ, Vakil N. Guidelines for the management of dyspepsia. Am J Gastroenterol. 2005;100(10):2324-37.
9. Franceschi F, Gasbarrini A, Polyzos SA, Kountouras J. Extragastric diseases and Helicobacter pylori. Helicobacter. 2015;20 Suppl 1:40-6.
10. Chey WD, Wong BC. American College of Gastroenterology guideline on the management of Helicobacter pylori infection. Am J Gastroenterol. 2007;102(8):1808-25.
11. Malfertheiner P, Megraud F, O'Morain CA, et al. Management of Helicobacter pylori infection--the Maastricht IV/ Florence Consensus Report. Gut. 2012;61(5):646-64.
12. El-Serag HB, Kao JY, Kanwal F, et al. Houston Consensus Conference on Testing for Helicobacter pylori Infection in the United States. ClinGastroenterolHepatol. 2018;16(7):992-1002.e6.
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Nov 28, 2024
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How to Cite
Qasim Shah, Farah Rabbani, Muhammad Sajid, Medrar Ullah Khan, Muhammad Waqas, Abdul Waris, Zia Ud Din, & Tarmim Lal. (2024). ASSOCIATION OF HELICOBACTER PYLORI INFECTION WITH METHOTREXATE-INDUCED GASTROINTESTINAL INTOLERANCE IN RHEUMATOID ARTHRITIS: A PROSPECTIVE STUDY USING H. PYLORI STOOL ANTIGEN TEST. Journal of Population Therapeutics and Clinical Pharmacology, 31(11), 1829-1835. https://doi.org/10.53555/gk7gt865
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Author Biographies
Qasim Shah
Trainee Medical Officer, Department of Rheumatology, Lady Reading Hospital, Peshawar, Pakistan
Farah Rabbani
Trainee Medical Officer, Department of Rheumatology, Lady Reading Hospital, Peshawar, Pakistan
Muhammad Sajid
Trainee Medical Officer, Department of Rheumatology, Lady Reading Hospital, Peshawar, Pakistan
Medrar Ullah Khan
Trainee Medical Officer, Department of Rheumatology, Lady Reading Hospital, Peshawar, Pakistan
Muhammad Waqas
Trainee Medical Officer, Department of Rheumatology, Lady Reading Hospital, Peshawar, Pakistan
Abdul Waris
Trainee Medical Officer, Department of Rheumatology, Lady Reading Hospital, Peshawar, Pakistan
Zia Ud Din
Assistant Professor, Department of Rheumatology, Lady Reading Hospital, Peshawar, Pakistan
Tarmim Lal
Trainee Medical Officer, Department of Rheumatology, Lady Reading Hospital, Peshawar, Pakistan
How to Cite
Qasim Shah, Farah Rabbani, Muhammad Sajid, Medrar Ullah Khan, Muhammad Waqas, Abdul Waris, Zia Ud Din, & Tarmim Lal. (2024). ASSOCIATION OF HELICOBACTER PYLORI INFECTION WITH METHOTREXATE-INDUCED GASTROINTESTINAL INTOLERANCE IN RHEUMATOID ARTHRITIS: A PROSPECTIVE STUDY USING H. PYLORI STOOL ANTIGEN TEST. Journal of Population Therapeutics and Clinical Pharmacology, 31(11), 1829-1835. https://doi.org/10.53555/gk7gt865