Why does stomach pain occur in a 75-year-old with RA?

Question

Hello doctor,

I am a 75-year-old male with rheumatoid arthritis. I have had bad stomach pain for six to seven months. The pain is intermittent during the day and wakes me at night. This is happening almost every day and night. I get bloated sometimes, and I have nausea and decreased appetite. I weigh 80 kgs, and it has been unchanged. Sometimes food will relieve the pain, but the pain returns within two hours. There were blood traces in my stools, but a colonoscopy was clear.

I am anemic. There is no previous history, although it has been ongoing for seven months. The pain seems to be on the right side of the middle and upper region of the stomach, but it can move around. Sometimes, the pain is in the range of 7 out of 10. Other times, it can be mild discomfort.

I am currently under the following medications.

1. Methotrexate 25 mg, once a week.

2. Folic acid 5 mg, once a week.

3. Aspirin 100 mg (enteric-coated), once daily.

5. Atorvastatin 40 mg tablet, once daily.

Please advise regarding the pain, as I have little quality of life.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

The symptoms you describe fit into the description of the acid peptic disease and peptic ulcers. The culprits for this are Aspirin and Methotrexate. So the first step to treating this will be switching from Aspirin and Methotrexate to a better alternative drug like Clopidogrel and Leflunomide. Secondly, you should take proton pump inhibitors like tablet Rabeprazole 20 mg twice daily for a month. Syrup Sucralfate, two teaspoons twice a day, will help form a coating on the ulcer and decrease the pain. Thirdly, tablet Normaxin (Chlordiazepoxide + Clidinium bromide and Dicyclomine HCl) will help with bloating and calm your gut.

Kindly revert in case of further queries.

Thank you.