Asymptomatic gastritis in naproxen‐treated North Indian children with juvenile rheumatoid arthritis

Abstract

AbstractAims: Nonsteroidal anti‐inflammatory drugs (NSAIDs) are the agents of choice in patients with juvenile rheumatoid arthritis (JRA). While NSAIDs have been associated with gastritis in adults with rheumatoid arthritis (RA), not much is known about children with JRA. In this prospective study we set out to evaluate 31 children with JRA, who fulfilled the diagnostic criteria given by the American College of Rheumatology (ACR).Methods: All patients had received naproxen for at least 3 months prior to their enrolment. Mean age of children was 9.02 years (range 2.5–16 years) with the male : female ratio being 1.8 : 1 (boys 20; girls 11). Eleven (35.5%) patients had polyarticular, 15 (48.4%) had pauciarticular and the remaining five (16.1%) had systemic onset JRA. Duration of disease varied from 5–84 months (mean ± 2, SD = 25.32 ± 20 months) with a mean duration of therapy of 14.19 months (range 4–72 months). Six patients had complaints of mild non‐specific upper abdominal pain.Results: On upper gastrointestinal endoscopic examination none of the children showed any significant gross findings. However, histopathology of antral biopsies showed features of active and/or chronic gastritis in almost all the patients. Helicobacter pylori was identified in 16 (51.8%) of these on hematoxylin and eosin staining and the findings were confirmed with Giemsa/Gram staining. Fourteen (85.5%) were also positive by the rapid urease test (RUT). Ten of the 16 patients with H. pylori infection showed evidence of active inflammation in the antral biopsies.Conclusions: Asymptomatic gastritis is a common finding in children with JRA who are receiving naproxen. There appears to be no correlation between the presence of H. pylori infection or histological gastritis and presence of abdominal symptoms in children with JRA.