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RA and Gallbladder Issues: Gallstones, Removal, and More

Posted on July 06, 2022
Medically reviewed by
Diane M. Horowitz, M.D.
Article written by
Scarlett Bergam, M.P.H.

Rheumatoid arthritis (RA) is most commonly associated with joint inflammation and pain. However, this chronic autoimmune disease can have effects on many other organ systems, including the bones, lungs, and blood — and potentially the gallbladder.

The gallbladder is an organ directly below your liver that stores bile — digestive juice made by the liver — and then releases it through the bile duct to the duodenum (the opening of the small intestine) after a meal. However, bile sometimes gets trapped along the biliary system (or biliary tract), creating a blockage that can cause gallbladder disease.

If you have RA, you may wonder whether it’s connected to gallbladder disease. The following guide can help you discover whether the two conditions are linked and how they can affect you.

Common Gallbladder Disorders

The many types of gallbladder disease include:

  • Gallstones, found in the gallbladder (cholelithiasis) or the bile duct (choledocholithiasis) — The most common types include cholesterol and pigment gallstones.
  • Large tissue growths (polyps)
  • Swelling (cholecystitis)

When gallstones or polyps form in the gallbladder, they may block the flow of bile out of the liver. These growths can trap bile and cause it to build up in the gallbladder, which leads to swelling, inflammation, and pain (acute cholecystitis).

Complications of untreated, symptomatic gallbladder disease over time include:

  • Gallbladder and bile duct infections (cholangitis)
  • Death of tissue (gangrene) along the gallbladder wall
  • Harm to the bile duct, leading to liver damage (cirrhosis) and pancreas inflammation (pancreatitis)
  • Lower bile storage in the gallbladder

For mild or new cases of gallbladder disease, your health care provider may try various nonsurgical treatments. They may ask you to make dietary changes, such as adopting a low-fat diet, because cholesterol and saturated fat can worsen gallbladder function. You may also receive oral dissolution therapy, a medication produced from bile acid that can dissolve kidney stones.

Maintaining an empty stomach and taking IV antibiotics or pain medicine may help reduce your symptoms while you’re being treated during a flare-up (period of worsening symptoms). You may receive a specialized, noninvasive surgery called endoscopic retrograde cholangiopancreatography, which can both diagnose and treat gallbladder disease.

If flares continue or worsen over time, the most effective form of treatment is surgical gallbladder removal, also known as cholecystectomy. Laparoscopic cholecystectomy, which involves small incisions, is less invasive than open surgery. A person who has laparoscopic surgery usually can return home the same day. Although gallbladder surgery comes with minor risks, just like any other surgery, most people can live a normal life without a gallbladder.

Member Experiences With RA and Gallbladder Issues

Many myRAteam members have experienced gallbladder disease, and some wonder whether the condition was related to their RA. One member asked, “Does anyone suspect a link between their RA and gallbladder problems? I had emergency surgery in 2010 for gangrenous cholecystitis, and I saw online that RA could possibly be a risk factor.”

Some saw the connection. “My doc feels that a gallbladder attack (and emergency surgery) triggered the sudden onset of my RA,” a member replied. Another discussed a similar timeline: “I had emergency surgery for gangrenous cholecystitis in August 2014. My PCP [personal care physican] strongly suspected RA in November 2014, and it was confirmed by my rheumatologist in December 2014.”

Others thought the conditions weren’t necessarily related: “I had my gallbladder removed in 1995, many years before being diagnosed with RA.”

Could RA Be Associated With Gallbladder Issues?

RA is an inflammatory and autoimmune disease. The immune system attacks the body’s healthy cells, causing inflammation. Inflammatory symptoms can appear throughout the body, leading to a variety of conditions.

Some researchers have studied the co-occurrence of autoimmune conditions and gallbladder issues. One study of nearly 6,000 individuals from a general population in Denmark detected gallstone disease in 10 percent of participants (6.8 percent with gallstones and 3.2 percent with cholecystectomy). Having a chronic autoimmune condition increased the likelihood of having gallbladder disease. However, unlike other autoimmune conditions, rheumatoid arthritis had no significant association with gallbladder disease.

A smaller study, which involved 84 women, linked RA with a 2.3 times greater risk of developing gallbladder disease in women 60 years and older. The researchers suggested that this correlation is due to chronic inflammation over time. In participants under age 60, there was no significant difference in the risk of gallstones between those with and without RA.

Could RA Medication Cause Gallbladder Issues?

Many drugs have been linked to an increased risk of gallbladder issues, including some oral contraceptives, antibiotics, chemotherapy agents, narcotics, and blood thinners. Most RA treatments have no known relationship with gallbladder disease. However, some treatments have reportedly led to gallbladder disease in some people, including cyclosporine (sold as Neoral) — a type of disease-modifying antirheumatic drug, or DMARD — and dapsone (an anti-inflammatory drug. Always read the U.S. Food and Drug Administration (FDA) drug labels for your medications to understand the risks and side effects, and talk with your doctor if you have questions.

Shared Risk Factors for RA and Gallbladder Issues

The risk of developing rheumatoid arthritis is similar to that of having gallbladder disease due to other risk factors, which include:

  • Being female
  • Being pregnant
  • Having an impaired immune system
  • Being older or middle-aged
  • Having a family history of gallstones
  • Being Native American, Hispanic, or Caucasian
  • Consuming a diet high in saturated fat and cholesterol
  • Being obese or losing weight rapidly (for example, through bariatric surgery)
  • Having diabetes

Many of the risk factors for developing gallstone disease are similar to the risk factors of RA, particularly pertaining to sex, age, obesity, and immune system health. If you have experienced gallstones, even if they are not directly linked to your RA, they may originate from similar causes.

Symptoms To Evaluate

The most common symptoms of gallbladder disease include abdominal pain and bloating, nausea and vomiting, fever, and jaundice (yellowing of skin and eyes). Gastrointestinal issues such as heartburn and indigestion are not typically associated with gallbladder disease.

About 90 percent of the time, gallbladder disease is asymptomatic, and many people go undiagnosed for more than 10 years until symptoms begin. If you’re worried that you’re experiencing symptoms or may be at high risk of developing gallbladder disease, speak with your doctor about receiving a blood test to identify certain elevated enzymes (such as bilirubin) or having imaging tests (ultrasound, X-ray, CT scan, or MRI).

If you experience severe, persistent, gripping pain in the upper right abdomen that radiates to your back, perhaps with nausea and vomiting, you may be experiencing a biliary colic attack. These symptoms can be life-threatening, so head to your local emergency department to get a diagnosis and necessary treatment.

Talk With Others Who Understand

On myRAteam, the social network for people with rheumatoid arthritis and their loved ones, more than 193,000 members come together to ask questions, give advice, and share their stories with others who understand life with RA. Here, finding information on illnesses and symptoms related to RA is a common topic.

Have you experienced gallbladder issues while living with RA? Have you asked your doctor about a possible connection between the two conditions? Share your experience in the comments below, or start a conversation by posting on your Activities page.

All updates must be accompanied by text or a picture.
Diane M. Horowitz, M.D. is an internal medicine and rheumatology specialist. Review provided by VeriMed Healthcare Network. Learn more about her here.
Scarlett Bergam, M.P.H. is a medical student at George Washington University and a former Fulbright research scholar in Durban, South Africa. Learn more about her here.

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