An Overview of GI Problems In Rheumatoid Arthritis

GI Events, What to Look Out For, Causes and Prevention

Stomach Pain

LightFieldStudios / Getty Images

If you have rheumatoid arthritis (RA), you are probably familiar with joint pain, stiffness, and swelling. You may also experience gastrointestinal (GI) problems. And you are probably not alone. Research shows people with rheumatoid arthritis struggle with more digestive system issues than others without the disease.

A study reported in 2012 by the Journal of Rheumatology followed 813 people with RA and 813 people without RA for 10 years. They found that the people with RA had a 70% higher risk of developing an upper GI problem and a 50% greater chance for a lower GI issue, this in comparison to others without RA.

Here is what you need to know about GI problems associated with rheumatoid arthritis, causes, what to look for, and how you can prevent these.

GI Events and RA

Your GI tract has an upper or lower section, and rheumatoid arthritis can affect both. The upper GI system runs from the mouth to where the stomach empties into the small intestine. The lower GI system is all of the small intestine and large intestine.

Upper GI events include perforation (hole in the wall of the GI tract), bleeding, ulcers, obstruction, and esophagitis, a condition that causes inflammation of the esophagus. The esophagus is the hollow, muscular tube that carries food and liquids from the throat to the stomach.

Lower GI events include bleeding, perforation, ulcers, colitis (swelling of the large intestine), and diverticulitis (infection or inflammation of the small sacs that line the intestines).

A study reported in the journal Gastroenterology Research and Practice compared 284 people with rheumatoid arthritis to 233 people without RA. All study participants were asked questions about upper and lower GI events.

The researchers found that upper GI symptoms, including stomach pain, nausea, and feeling full quickly, were common in people with RA compared to others without the condition. They also determined people with rheumatoid arthritis used laxatives and proton pump inhibitors (drugs to reduce stomach acid) more often.

Causes of GI Problems in RA

Several factors may contribute to GI problems associated with rheumatoid arthritis, including inflammation, coexisting conditions, gut problems, and medications used to treat RA.


GI conditions are common in inflammatory arthritis and include inflammatory bowel disease (IBD), a disorder characterized by inflammation of the digestive system. This is because the same inflammation process targeting your joints can also affect your digestive system.

Coexisting Conditions

Rheumatoid arthritis is associated with other conditions, including conditions affecting the GI tract, like IBD and celiac disease—a disorder that causes the immune system to overact to gluten.

Gut Bacteria

Researchers have looked at the connection between stomach bacteria in the GI tract and rheumatic diseases. In addition to the many communities of harmless bacteria, your gut also has unbalanced bacterial colonies called gut dysbiosis, which are closely linked to inflammatory diseases like RA. Gut dysbiosis is associated with numerous GI troubles and events.


GI symptoms can be a side effect of some of the medications you take to treat RA, including disease-modifying antirheumatic drugs (DMARDs), nonsteroidal anti-inflammatory drugs (NSAIDs), and corticosteroids.

A 2018 study reported by the International Journal of Rheumatic Disease found people taking 12 milligrams (mg) per week of methotrexate—a DMARD—were more likely to experience acid reflux and abdominal pain than those taking a lower dose of 6 mg per week.

NSAIDs can also irritate the GI tract and are strongly linked to upper GI problems, including ulcers, bleeding, and inflammation of the esophagus.

What To Look Out For

Minor stomach discomfort may not be significant, but if you are having frequent GI issues, this might be a sign of a bigger problem.

GI problems experienced by people with rheumatoid arthritis may include:

  • An ulcer or perforation of the stomach, small intestine, or large intestine
  • Inflammation of the esophagus
  • Infection and inflammation of the small or large intestine
  • Celiac disease—symptoms include diarrhea, fatigue, bloating, gas, stomach pain, constipation, nausea, and vomiting after eating foods containing gluten 
  • Inflammatory bowel disease—symptoms include diarrhea, abdominal pain, fatigue, rectal bleeding/bloody stools, and unintentional weight loss

Symptoms associated with GI problems in rheumatoid arthritis may include:

  • Dysphagia—difficulty swelling
  • Abdominal pain
  • Indigestion, upper abdominal discomfort that includes a burning sensation, bloating and gas, nausea, or feeling full quickly after starting to eat
  • Heartburn or acid reflux, when stomach acid escapes into the esophagus causing inflammation and irritation
  • Black, tarry stools from upper GI bleeding
  • Bloody stools from lower GI bleeding
  • Constipation
  • Leaking of stool      
  • Diarrhea


It is a good idea to be aware of GI symptoms associated with rheumatoid arthritis and let your doctor know about them, especially if you experience severe abdominal pain and GI bleeding.

You should always follow your doctor’s advice for finding relief from symptoms, which will likely include not smoking, limiting steroid medications and NSAIDs, and taking proton pump inhibitors to reduce symptoms.

If you find certain foods cause you stomach troubles, or make your RA symptoms worse, talk to your doctor or a dietitian about how to eliminate those from your diet. 

You will want to avoid foods like:

  • Acidic foods including citrus fruits and tomatoes, which may cause discomfort and irritate your stomach lining
  • Dairy products if you are lactose intolerant or experience digestive problems after consuming them
  • Hot and spicy foods because they may trigger indigestion and heartburn
  • Alcohol to reduce heartburn and other GI symptoms

Always check with your doctor before taking probiotics or dietary supplements, or before making any big diet changes.

A Word From Verywell

If you are experiencing GI symptoms associated with rheumatoid arthritis consistently, make an appointment to see your doctor. Make sure you write down your symptoms to see if you can narrow down triggers. The more information you can provide your doctor, the easier will be for them to determine what is causing your symptoms and how to best manage them. 

Was this page helpful?
Article Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Myasoedova E, Matteson EL, Talley NJ, et al. Increased incidence and impact of upper and lower gastrointestinal events in patients with rheumatoid arthritis in Olmsted County, Minnesota: a longitudinal population-based study. J Rheumatol. 2012;39(7):1355-1362. doi:10.3899/jrheum.111311

  2. The National Institute of Diabetes and Digestive and Kidney Diseases. Your digestive system & how it works. Updated December 2017.

  3. Myasoedova E, Talley NJ, Manek NJ, et al. Prevalence and risk factors of gastrointestinal disorders in patients with rheumatoid arthritis: results from a population-based survey in Olmsted County, Minnesota. Gastroenterol Res Pract. 2011;2011:745829. doi:10.1155/2011/745829

  4. Ribaldone DG, Pellicano R, Actis GC. Inflammation in gastrointestinal disorders: prevalent socioeconomic factors. Clin Exp Gastroenterol. 2019;12:321-329. doi:10.2147/CEG.S210844

  5. Picchianti-Diamanti A, Panebianco C, Salemi S, et al. Analysis of gut microbiota in rheumatoid arthritis patients: disease-related dysbiosis and modifications induced by etanercept. Int J Mol Sci. 2018;19(10):2938. doi:10.3390/ijms19102938

  6. Asai S, Nagai K, Takahashi N, et al. Influence of methotrexate on gastrointestinal symptoms in patients with rheumatoid arthritis. Int J Rheum Dis. 2019 Feb;22(2):207-213. doi: 10.1111/1756-185X.13380

  7. Goldstein JL, Cryer B. Gastrointestinal injury associated with NSAID use: a case study and review of risk factors and preventative strategiesDrug Healthc Patient Saf. 2015;7:31-41. doi:10.2147/DHPS.S71976