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Article Type

Original Study

Abstract

Objective The aim of the study was to assess the effect of Helicobacter pylori treatment on disease activity in patients with rheumatoid arthritis. Background A triggering infectious agent has long been postulated in rheumatoid arthritis. Data on the possible role of H. pylori infection are lacking. Patients and methods Forty adult patients with established rheumatoid arthritis and dyspeptic symptoms were recruited. In all, 17 patients were H. pylori positive and 23 patients were H. pylori negative on the basis of H. pylori fecal antigen test. All infected patients were treated successfully. We evaluated the disease activity using clinical [duration of morning stiffness, tender and swollen joints counts, Disease Activity Score 28 (DAS28), visual analog scale (VAS), and Health Assessment Questionnaire (HAQ)] and laboratory parameters such as complete blood count, erythrocyte sedimentation rate, C-reactive protein (CRP), and rheumatoid factor titer at baseline and after 2 months and compared the variations in the two subgroups. Results At the initiation of the study, H. pylori-positive patients had significantly longer duration of morning stiffness, more tender and swollen joint counts, and higher value of CRP than the negative group. In addition, the DAS28 and pain scores such as VAS and HAQ were significantly higher in the positive group. After 2 months, H. pylori-eradicated rheumatoid arthritis patients differed significantly (P = 0.009-0.001) from patients without H. pylori infection in terms of improvement of tender and swollen joints count, DAS28, VAS, and HAQ. At the same time point, several laboratory indices (CRP and rheumatoid factor titer) showed significantly lower values (P = 0.003-0.001) in the H. pylori-eradicated subgroup compared with the H. pylori-negative subgroup. Conclusion Our data suggest that H. pylori infection is implicated in the pathogenesis of rheumatoid arthritis; its treatment may induce a significant improvement of disease activity over 2 months. H. pylori treatment seems to be advantageous in infected rheumatoid arthritis patients, but controlled studies are needed.

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