Rheumatoid arthritis (RA) is a chronic, multisystemic disease that may manifest beyond the articular structures. Gastrointestinal (GI) disease in RA can take on many forms, although iatrogenesis is its most common cause. GI involvement due to the disease per se occurs, in general, in patients with a long-standing history of untreated RA and it may be fatal. Dysphagia, hepatotoxicity, bleeding, infarction, and perforation should be considered on the differential diagnosis in patients with RA. Likewise, manifestations of associated syndromes such as Felty and Sjögren may also occur and need to be considered. Physicians should carefully monitor patients on nonsteroidal antiinflammatory drugs, disease-modifying antirheumatic drugs, and biologics for the occurrence of GI adverse events. Finally, it should be noted that numerous diseases affect the GI tract and articular surfaces in close temporal relationship, and a careful history remains essential to properly sort them out.