FREQUENCY OF HELICOBACTER PYLORI VIRULENCE GENES IN PATIENTS WITH RHEUMATOID ARTHRITIS AND NSAID-ASSOCIATED GASTROPATHY

Abstract

This study examined the frequency of Helicobacter pylori (Hp) virulence gene occurrence and their combinations in patients with rheumatoid arthritis (RA) receiving nonsteroidal anti-inflammatory drugs (NSAIDs). Sixty-nine patients with RA and gastrointestinal complaints were examined and divided into two groups: 45 patients (66%) with gastropathy and 24 patients (34%) without gastropathy. Hp genotypes were characterized in gastric biopsy material using polymerase chain reaction. The cagA, iceA2, and vacAs2 genotypes were significantly more frequent in patients with gastropathy than in those without (cagA: 42.2% vs 16.7%, OR=3.6, P=0.029; iceA2: 35.6% vs 20.8%, OR=2.1, P=0.2; vacAs2: 46.7% vs 16.7%, OR=4.4, P=0.011). The combination of cagA, iceA2, vacAm1, and vacAs2 genotypes occurred in 31.1% of patients with gastropathy versus 4.2% of patients without gastropathy, corresponding to a 10.4 fold increase in gastropathy risk (OR=10.4, 95% CI 1.273-84.75, P=0.011). These findings indicate that specific Hp genotype combinations, rather than individual virulence genes alone, are associated with a substantially elevated risk of NSAID-associated gastropathy in patients with RA, supporting the potential clinical value of combined genotyping for risk stratification prior to long-term NSAID therapy.