Nonsteroidal antiinflammatory drug–induced enteropathy and severe chronic anemia in a patient with rheumatoid arthritis

✍ Scribed by Neal M. Davies; Fakhreddin Jamali; Kenneth J. Skeith

• Publisher: John Wiley and Sons
• Year: 1996
• Tongue: English
• Weight: 373 KB
• Volume: 39
• Category: Article
• ISSN: 0004-3591
• DOI: 10.1002/art.1780390222

✦ Synopsis

This report describes the case of a woman who was admitted to the hospital with severe anemia and refractory rheumatoid arthritis. She had been transfusion dependent for 8 years and was receiving a combination of indomethacin and naproxen. An indium-1 11 white blood cell scan revealed small bowel inflammation. Salsalate was substituted for her previous nonsteroidal antiinflammatory drugs (NSAIDs), and metronidazole was initiated. This resulted in maintenance of a normal hemoglobin level for at least 1 year after discharge. Small intestine inflammation and bleeding (enteropathy) due to NSAIDs must be considered in the evaluation of anemia in patients with arthritis.

We describe a woman with a 14-year history of rheumatoid arthritis (RA), persistent synovitis, and transfusion-dependent anemia of 8 years' duration. A white blood cell (WBC) scan showed focal accumulation of WBCs in the right lower abdominal quadrant, indicative of an inflammatory process involving the small bowel. Elimination of long-term nonsteroidal antiinflammatory drug (NSAID) therapy resulted in a complete and sustained resolution of her anemia. Small bowel enteropathy is an uncommon clinical manifestation of NSAID therapy, but the effects of NSAID ingestion on the intestine must be considered in the evaluation of undiagnosed blood loss and iron deficiency anemia.