Rheumatoid Arthritis and Sjogren’s Disease

Gastrointestinal (GI) symptoms in rheumatoid arthritis (RA) are most commonly due to adverse effects of NSAIDs and steroids, but manifestations secondary to the disease itself do occur, such as rheumatoid vasculitis, secondary amyloidosis, and Felty’s syndrome with nodular regenerative hyperplasia. These entities are more likely to present in patients with longstanding, seropositive, and erosive disease and often portend a poor prognosis. In Sjogren’s disease, gastrointestinal symptoms are varied and include sequelae of oral sicca, enteric failure from autonomic neuropathy, gastritis, and other autoimmune overlap such as primary biliary cholangitis. Herein, we describe the epidemiology, risk factors, presentation, and management of the gastrointestinal manifestations of both diseases. Although primary gastrointestinal symptoms are less common than the hallmark manifestations of RA and Sjogren’s, they require a high index of suspicion given their potential impact on quality of life and mortality.