Rheumatoid arthritis and gastrointestinal symptoms

Rheumatoid arthritis (RA) is an autoimmune disease that primarily affects a person’s joints. However, RA can also cause symptoms that affect the gastrointestinal system (GI), such as nausea, indigestion, and abdominal pain.

The GI system contains many different organs, including:

This article discusses the effects of RA on the GI system and the symptoms that result from it. It also provides information about the relationship between GI problems and RA medication, as well as treatment options and prevention methods.

There are many important links between the GI system and RA. Some scientists believe that RA could occur due to complex interactions between the gut microbiome, genetics, and environmental factors.

RA is an autoimmune disease. This means that it occurs when a person’s immune system, whose job it is to protect the body from disease, attacks healthy cells instead.

The main symptom of RA is inflammation of the joints. However, RA can affect almost any organ in the body, including the GI system.

According to the Arthritis Foundation (AF), people with RA are about 70% more likely to develop GI problems than people without the condition.

This can happen for a number of reasons, such as:

  • A side effect of RA medication: Disease-modifying anti-inflammatory drugs (DMARDs), nonsteroidal anti-inflammatory drugs (NSAIDs), and corticosteroids can all cause symptoms such as constipation, pain, diarrhea, and gas.
  • Infection: DMARDs can decrease the body’s ability to fight off infection. This can lead to infectious colitis or diverticulitis of the gastrointestinal tract.
  • Other autoimmune diseases: People with RA are more likely to develop certain autoimmune diseases that can cause gastrointestinal problems. Examples include inflammatory bowel disease (IBD), celiac disease, and autoimmune hepatitis.
  • A direct result from RA: Once RA develops in a person’s body, it can cause other conditions that can lead to GI problems, such as Felty’s syndrome, which can affect the liver. According to the AF, about 5% of patients with RA develop rheumatoid vasculitis (RV), which leads to inflammation in the gastrointestinal tract.

Some RA drugs can cause GI side effects. The AF notes that drugs for RA are the most likely cause of GI symptoms.

A 2018 article lists some common RA drugs along with their side effects.


NSAIDs can help relieve pain and reduce inflammation. However, prolonged use can lead to:


DMARDs are a group of drugs that help slow the progression of RA. However, they can cause the following GI symptoms:

DMARDs can also decrease the body’s ability to fight off infection. As a result, bacterial infections such as bacterial colitis and diverticulitis can occur.

Bacterial infectious colitis can cause abdominal pain and diarrhea. Diverticulitis can cause diarrhea, constipation, and abdominal pain in the lower left area.


Corticosteroids can reduce inflammation. However, they can also weaken the immune system. This increases the chances of developing fungal infections like oral thrush.

Symptoms of oral thrush include:

  • Cracks at the corners of the mouth
  • an unpleasant taste in the mouth
  • Mouth pain, like sore gums
  • Difficulty drinking and eating
  • Loss of the ability to taste things

Corticosteroids can also cause ulcers and visceral perforations if a hole forms through the stomach, colon, or small intestine.

Visceral perforation can cause severe stomach pain, nausea, vomiting, chills, and fever.

Tumor necrosis factor inhibitors

Tumor necrosis factor (TNF) inhibitors help reduce inflammation. However, they can cause the following GI symptoms:

  • stomach pain
  • Nausea
  • Vomit
  • diarrhea
  • Mouth ulcers
  • Gastritis, which is inflammation of the lining of the stomach
  • Hepatotoxicity

They can also cause intestinal obstruction, which can lead to:

Bowel perforations can also occur, which can lead to:

  • severe abdominal pain
  • fever
  • chills
  • Abdominal swelling and gas
  • Nausea
  • Vomit

Research has shown that RA can affect the GI system in a number of ways.

Below we describe these conditions along with their symptoms.


Rarely, people with RA develop RV. This can affect about 5% of patients with RA.

RV is the inflammation and narrowing of blood vessels. Although it typically affects the nerves, skin, fingers, and toes, it can also cause inflammation in the gastrointestinal tract.

GI symptoms of RV include:

  • Weight loss
  • Loss of appetite
  • stomach pain
  • diarrhea
  • Stomach ulcers
  • Ulcers in the esophagus
  • Intestinal perforation
  • Blood in the stool

Other symptoms are:

Felty syndrome

In rare cases of RA, people can develop felty syndrome. This condition causes various abnormalities in the liver, including:

  • an enlarged liver
  • Varicose veins, which are swollen or enlarged veins
  • Fluid build-up in the abdomen

People with RA are more likely to develop certain autoimmune diseases that can cause gastrointestinal problems.

These conditions include:

Autoimmune hepatitis

Symptoms of autoimmune hepatitis vary, but can include:


Symptoms of IBD include:

  • Abdominal pain, cramps and swelling
  • bloody and recurring diarrhea
  • Weight loss

Celiac disease

Celiac disease can manifest itself in a number of ways, including:

Secondary Sjogren’s disease

Secondary Sjogren’s disease occurs alongside rheumatic diseases such as RA.

Up to 31% of people with RA can develop secondary Sjogren’s disease. In people with RA, this condition affects the mouth.

It can lead to dry mouth, which can make chewing or swallowing difficult. It also causes enlarged parotid glands, the two salivary glands right in front of the ears that produce saliva to help with chewing and digestion.

AA amyloidosis

AA amyloidosis is another rare complication of RA that affects 0.6–1.1% of people with this type of arthritis.

It can affect the esophagus, stomach, intestines, liver, or gallbladder in people with RA.

Symptoms include:

Medical treatment for gastrointestinal complications of RA depends on the cause of the complications. For example, to treat a person’s amyloidosis, doctors need to address the underlying cause, which in this case is RA.

However, some RA treatments can cause GI symptoms.

To relieve mouth sores, a person can try a saltwater rinse or use a mouthwash that contains lidocaine.

Additionally, a doctor may be able to prescribe anti-nausea medication to relieve nausea.

A person can discuss ways to reduce GI symptoms with a rheumatologist.

Certain gastrointestinal symptoms can be more difficult to treat than others. For example, because RV is a rare complication of RA, scientists haven’t accumulated much quality evidence of effective treatments.

A person with RA may also be able to relieve certain GI symptoms, such as nausea and dry mouth, without taking medication. A doctor can advise you on safe home remedies to manage such symptoms.

In addition, physiological health conditions can have a negative impact on a person’s mental well-being. Therefore, some people with RA might benefit from taking care of their mental wellbeing by:

Anyone with GI symptoms should see a doctor right away.

The same goes for other symptoms of RA, such as:

It is also important for people taking RA medication to be aware of GI side effects.

RA is a common condition that affects the joints. However, there is a strong link between RA and the GI system. Therefore, RA can also lead to GI problems.

Although these symptoms can be difficult to manage, treatment options are available. A person should seek advice from a doctor in order to find the most appropriate treatment.

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