Uma Mahadevan, MD: Gastroenterology Update for the Rheumatologist

Rheumatology Network sat down with Uma Mahadevan, MD, to discuss her Rheumatology Winter Clinical Symposium presentation, “Gastroenterology Update for the Rheumatologist.” Mahadevan is a gastroenterologist, Professor of Medicine, and Director of the University of California San Francisco Colitis and Crohn’s Disease Center.

Mahadevan focuses her discussion on non-alcoholic fatty liver disease (NAFLD), which is increasing in incidence, alongside obesity, around the world. One of the most common causes of cirrhosis, NAFLD is independently associated with rheumatoid arthritis (RA) and is more prevalent in patients with RA than the general population, leading to a higher number of patients developing fatty liver, fibrosis, and a higher percentage of patients requiring liver transplant. Additionally, medications such as methotrexate, which are commonly used for treating rheumatic disease, are associated with NAFLD. NAFLD also increases the risk of cardiac disease, non-liver cancer, and cirrhosis.

It’s imperative for rheumatologists who recognize an elevation in liver tests to schedule an ultrasound to look for fatty liver and refer these patients to a hepatologist for further evaluation. They should also counsel their patients on weight loss, exercise, and diet, which is the most important step in minimizing fatty liver disease, especially early on in their journey. Further, NAFLD impacts other areas of the body, such as an increase in the prevalence of kidney disease, type 2 diabetes, heart disease, and sleep apnea.

Many of the same medications used in treating rheumatic diseases are used to treat inflammatory bowel disease (IBD). Gastroenterologists, like Mahadevan, are focused on healing the lining of the colon. Treat-to-target therapies are used to reduce organ damage in both patients with IBD and those with rheumatic diseases. Recently, the select JAK inhibitor, upadacitinib, has shown impressive numbers in induction and maintenance for ulcerative colitis, even in patients with inadequate response to anti tumor necrosis factor (TNF) therapy.

Concluding, Mahadevan stresses that her main area of interest is in pregnancy and IBD. “Rheumatologists are not using these medications throughout pregnancy at the same rate as gastroenterologists mostly out of fear for the mother and the child. But what's happening is that the mothers and the children have more complications in RA than the general population and that's most likely due to inflammation. Stopping therapy may actually be doing more harm.”

Watch the interview below: