Evaluating the Effects of Helicobacter pylori Eradication on Clinical Course of Rheumatoid Arthritis

Authors

Mashhad University of Medical Sciences, Mashahd, IR Iran

10.17795/rijm30563

Abstract

Background: Rheumatoid arthritis (RA) is a chronic systemic autoimmune disease which is recognized by symmetric inflammation of joints. Many factors have been proposed as its etiology including microbial infections. H. pylori has been considered as one of the infectious agents linked to RA; however, the data regarding this relation is controversial. Objectives: To determine the effects of H. pylori on clinical course of disease, we compared the clinical course and laboratory findings of two groups of RA patients, with and without H. pylori infection, during one year follow up after H. pylori eradication. Patients and Methods: One hundred adult RA patients (diagnosed according to the 2010 Revised ACR/EULAR Criteria) who referred to Rheumatology Clinic of Imam Reza Hospital were evaluated for H. pylori infection. Thirty-nine patients were positive for H. pylori; from them 30 patients underwent H. pylori standard treatment with three drugs including Amoxicillin (1 g/Bid), Clarithromycin (500 mg/Bid) and omeprazole (20 mg/Bid), for 10 days and PPI for one month. Seven H. pylori positive patients were excluded from the study because of inappropriate drug compliance and drug resistance and three patients did not refer for follow up. Overall, frothy RA patients, 20 with H. pylori infection, and 20 without H. pylori infection, were evaluated in the study. Patients' clinical findings and laboratory tests were evaluated in 5 consecutive visits; at the beginning of the study and every 3 months up to one year. H. pylori infection and its eradication were evaluated by fecal antigen test performed with Eliza method. Results: Patients of H. pylori positive group had a higher number of joints inflammation and tenderness during 5 evaluation visits and the difference in number of joints involvement between two groups was statistically significant. The difference between two groups for pain based on visual analog scale (VAS), DAS-ESR and DAS-CRP was also significant and higher in H. pylori positive group. The other clinical and laboratory tests including ESR, CRP, RF and anti-CCP were not significantly different between two groups. H. pylori eradication did not improve clinical course of disease and laboratory tests. Conclusions: Considering the results of this study, although having H. pylori infection in RA patients was accompanied with higher number of inflamed and tender joints, but H. pylori eradication did not improve patients’ clinical symptoms and laboratory tests. It seems that the effect of H. pylori infection eradication over disease activity in RA patients is not remarkable, if it does exist at all.

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  1. 1.Neovius M, Simard JF, Askling J, Artis study group. Nationwide prevalence of rheumatoid arthritis and penetration of diseasemodifying drugs in Sweden. Ann Rheum Dis. 2011;70(4):624–9.

    1. Almoallim HM, Alharbi LA. Rheumatoid arthritis in Saudi Arabia. Saudi Med J. 2014;35(12):1442–5. 3. Venables PJW, Maini RN. Clinical manifestations of rheumatoid arthritis. 2015. Available from: www.uptodate.com.
    2. Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham C3, et al. 2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheum. 2010;62(9):2569–81.
    3. Cohen SB. Targeting the B cell in rheumatoid arthritis. Best Pract Res Clin Rheumatol. 2010;24(4):553–63.
    4. Gaston JSH. Rheumatic diseases: Immunological mechanisms and prospects for new therapies. UK: Cambridge University Press; 1999.
    5. Smyk D, Rigopoulou EI, Baum H, Burroughs AK, Vergani D, Bogdanos DP. Autoimmunity and environment: am I at risk? Clin Rev Allergy Immunol. 2012;42(2):199–212.
    6. Shoenfeld Y, Gilburd B, Abu-Shakra M, Amital H, Barzilai O, Berkun Y, et al. The mosaic of autoimmunity: genetic factors involved in autoimmune diseases--2008. Isr Med Assoc J. 2008;10(1):3–7.
    7. Shoenfeld Y, Zandman-Goddard G, Stojanovich L, Cutolo M, Amital H, Levy Y, et al. The mosaic of autoimmunity: hormonal and environmental factors involved in autoimmune diseases--2008. Isr Med Assoc J. 2008;10(1):8–12.
    8. Cutolo M, Prete C, Walker J. Is stress a factor in the pathogenesis of autoimmune rheumatic diseases? Clin Exp Rheumatol. 1999;17(5):515–8.
    9. Scott DL, Wolfe F, Huizinga TW. Rheumatoid arthritis. Lancet. 2010;376(9746):1094–108.
    10. Pordeus V, Szyper-Kravitz M, Levy RA, Vaz NM, Shoenfeld Y. Infections and autoimmunity: a panorama. Clin Rev Allergy Immunol. 2008;34(3):283–99.
    11. Zentilin P, Seriolo B, Dulbecco P, Caratto E, Iiritano E, Fasciolo D, et al. Eradication of Helicobacter pylori may reduce disease severity in rheumatoid arthritis. Aliment Pharmacol Ther. 2002;16(7):1291–9.
    12. Hasni S, Ippolito A, Illei GG. Helicobacter pylori and autoimmune diseases. Oral Dise. 2011;17(7):621–7.
    13. Janssen M, Dijkmans BA, van der Sluys FA, van der Wielen JG, Havenga K, Vandenbroucke JP, et al. Upper gastrointestinal complaints and complications in chronic rheumatic patients in comparison with other chronic diseases. Br J Rheumatol. 1992;31(11):747–52.
    14. Yamanishi S, Iizumi T, Watanabe E, Shimizu M, Kamiya S, Nagata K, et al. Implications for induction of autoimmunity via activation of B-1 cells by Helicobacter pylori urease. Infect Immun. 2006;74(1):248–56.
    15. Seriolo B, Cutolo M, Zentilin P, Savarino V. Helicobacter pylori infection in rheumatoid arthritis. J Rheumatol. 2001;28(5):1195–6.
    16. Ishikawa N, Fuchigami T, Matsumoto T, Kobayashi H, Sakai Y, Tabata H, et al. Helicobacter pylori infection in rheumatoid arthritis: effect of drugs on prevalence and correlation with gastroduodenal lesions. Rheumatology (Oxford). 2002;41(1):72–7.
    17. Matsukawa Y, Asai Y, Kitamura N, Sawada S, Kurosaka H. Exacerbation of rheumatoid arthritis following Helicobacter pylori eradication: disruption of established oral tolerance against heat shock protein? Med Hypotheses. 2005;64(1):41–3.
    18. Steen KS, Lems WF, Visman IM, de Koning MH, van de Stadt RJ, Twisk JW, et al. The effect of Helicobacter pylori eradication on C-reactive protein and the lipid profile in patients with rheumatoid arthritis using chronic NSAIDs. Clin Exp Rheumatol. 2009;27(1):170.
    19. Showji Y, Nozawa R, Sato K, Suzuki H. Seroprevalence of Helicobacter pylori infection in patients with connective tissue diseases. Microbiol Immunol. 1996;40(7):499–503.
    20. Meron MK, Amital H, Shepshelovich D, Barzilai O, Ram M, Anaya JM, et al. Infectious aspects and the etiopathogenesis of rheumatoid arthritis. Clin Rev Allergy Immunol. 2010;38(2-3):287–91.
    21. Tanaka E, Singh G, Saito A, Syouji A, Yamada T, Urano W, et al. Prevalence of Helicobacter pylori infection and risk of upper gastrointestinal ulcer in patients with rheumatoid arthritis in Japan. Mod Rheumatol. 2005;15(5):340–5.
    22. Longo D, Fauci A, Kasper D, Hauser S, Jameson J, Loscalzo J. Disorders of the Gastrointestinal System. Harrison's Principles of Internal Medicine. 18th ed. McGraw-Hill Professional; 2011. p. 2451. 25. Gisbert JP, Pajares JM. Stool antigen test for the diagnosis of Helicobacter pylori infection: a systematic review. Helicobacter. 2004;9(4):347–68.
    23. Talamo J, Frater A, Gallivan S, Young A. Use of the short form 36 (SF36) for health status measurement in rheumatoid arthritis. Br J Rheumatol. 1997;36(4):463–9.
    24. Wen H, Luo J, Li J, Li X. Helicobacter pylori infection in rheumatic diseases. Arthritis Res Ther. 2012;14(Suppl 1):P74.
    25. Zentilin P, Garnero A, Tessieri L, Dulbecco P, Seriolo B, Rovida S, et al. [Can Helicobacter pylori infection be a risk factor for the severity of rheumatoid arthritis?]. Recenti Prog Med. 2000;91(4):175–80.
    26. Graff LB, Andersen LP, Gernow A, Bremmelgaard A, Bonnevie O, Bondesen S, et al. Helicobacter pylori and rheumatoid arthritis. J PreClin Clin Res. 2007;1(1):68–73.
    27. Saad S, Rashad N. The Relation between Helicobacter Pylori Infection and the Severity of Rheumatoid Arthritis. Bahrain Med Bull. 2014;36(4)
    28. Smyk DS, Koutsoumpas AL, Mytilinaiou MG, Rigopoulou EI, Sakkas LI, Bogdanos DP. Helicobacter pylori and autoimmune disease: cause or bystander. World J Gastroenterol. 2014;20(3):613–29.