Abstract
Peptic ulcer, gastrointestinal perforation, and amyloidosis associated with collagen disease were studied. Prospectively, peptic ulcer was found in 30 (22.3%) of 134 cases of rheumatoid arthritis (RA), and three (3.3%) of 90 cases of other collagen diseases. Peptic ulcer associated with RA was found much more in the stomach (86.7%) rather than in the duodenum (6.7%). 63.6% of gastric ulcer in RA was located in the antral region. 45.2% of peptic ulcer in RA was painless and incidentally found out. Periodic screening of peptic ulcer was recommended in RA patients. Two cases of intestinal perforation in patients with systemic lupus erythematosus (SUE) and mixed connective tissue disease (MCTD) were reported. In both cases, emergent operation revealed the multiple ulcer perforation in the small intestine. It was noticed that symptoms of peritonitis due to gastrointestinal perforation was somewhat masked in the patient with corticosteroid-treated collagen disease, and there was no obvious relationship between clinical or serological course and intestinal perforation. Nine cases of secondary amyloidosis associated with RA were described. Biopsy of the stomach was useful to diagnose amyloidosis (positive proportion for amyloid: 86%). Persistent diarrhea and gastrointestinal bleeding were hardly treatable, so that gastrointestinal amyloidosis was considered to be one of the life-threatening factor in the patients with amyloidosis associated with RA. In addition, randomized study of biopsy of the gastric antral region was performed in the outpatients with RA. Biopsy specimens positive for amyloid was found in one of 27 cases (4%).
