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

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.

Keywords:

Eradication , Rheumatoid Arthritis , Helicobacter pylori