Title: NSAIDs and Renal function in Rheumatoid Arthritis
Author: Soobia Karim Ansari
DOI: http://dx.doi.org/10.18535/jmscr/v4i2.51
Non-steroidal anti-inflammatory drugs(NSAIDs) are of the most commonly prescribed drugs in Rheumatoid Arthritis(RA).Their use carries a high risk of gastrointestinal and renal side effects. It is often difficult to differentiate between damage due to disease activity and that due to drugs (NSAIDs) used to treat rheumatoid arthritis. Although there are a number of parameters to study renal function, these cannot be applied to day to day practice and still remains research tools. In such a scenario, it is important to periodically monitor serum urea, serum creatinine and ESR, so as to pick up the earliest signs of inflammation and renal dysfunction in rheumatoid arthritis. For the above study 100 RA patients were enrolled, 50 being on NSAIDs. Elevated values i.e.S. urea (101.1%), S.creatinine (164.1%) and ESR (287%) was found in these subjects, which is statiscally significant. Treatment with Non-steroidal anti-inflammatory drugs (NSAIDs), showed decrease levels but it was not statistically significant. Hence, it is concluded from the above observation, that-raised levels of serum urea and serum creatinine is associated with rheumatoid arthritis and this in turn with variety of kidney disorders, principally due to chronic inflammation and drug exposure or toxicity. Keywords-Urea, Creatinine, RA, NSAIDs, ESR. 1. duthie, jjr,et al, annals of the rheumatic diseases,1964,23,193. 2. Lawson, AAH,and Maclean, N, Annals of the rheumatic diseases,1966,25,441. 3. Karie S, Gandjbakhch F, Janus N, et al. Kidney disease in RA patients: prevalence and implication on RA-related drugs management: the MATRIX Study. Rheumatology (Oxford). 2008;47 (3):350–354. 4. Nakamura T, Higashi S, Tomoda K, Tsukano M, Shono M. Etanercept can induce resolution of renal deterioration in patients with amyloid A amyloidosis secondary to rheumatoid arthritis. Clin Rheumatol. 2010; 29 (12):1395–1401. 5. Nakano M, Ueno M, Nishi S, et al. Analysis of renal pathology and drug history in 158 Japanese patients with rheumatoid arthritis. Clin Nephrol. 1998;50 (3):154–160. 6. Hall CL, Fothergill NJ, Blackwell MM, Harrison PR, mackenzie JC, maciver AG. The natural course of gold nephropathy: long term study of 21 patients. Br Med J. 1987;295(6601):745–748. 7. Hall CL, Jawad S, Harrison PR, et al. Natural course of penicillamine nephropathy: a long term study of 33 patients. Brmed J. 1988;296(6629):1083–1086. 8. Dijkmans BA, van Rijthoven AW, Goei Thè HS, Boers M, Cats A. Cyclosporine in rheumatoid arthritis. Semin arthritisrheum. 1992;22(1):30–36. 9. Yocum DE, Klippel JH, Wilder RL, et al. Cyclosporin A in severe, treatment-refractory rheumatoid arthritis. A randomized study. Ann Intern Med. 1988;109(11):863–869. 10. Laakso M, Mutru O, Isomaki H, Koota K. Mortality from amyloidosis and renal diseases in patients with rheumatoid arthritis. Ann Rheum Dis. 1986;45(8):663–667. 11. Whelton A. Nephrotoxicity of nonsteroidal anti-inflammatory drugs: physiologic foundations and clinical implications. Am J Med. 1999;106(5B):13S-24S. 12. E Pathan,et al.J Assoc Physician India.2003.Nov;51:1045-9. 13. Bjarrason I, Zanelli G, Smith T, et al. Non steroidal anti-inflammatory drugs induced intestinal inflammation in humans. Gastroenterology, 1987; 93:480-9. 14. Carlson L.A.,et al.Risk factors for myocardial infarction in the Stockholm Prospective Study .Acta Med.Scand.1979.206;351-60. 15. Barland P,Lipstein E.Selection and use of laboratory tests in the rheumatic disease.1996.Am J Med;100(suppl):16S-23S. 16. Boer M,et al. Errors in the prediction of creatinine clearance in patients with rheumatoid arthritis.Br J Rheum 1988;27:233-235. 17.Fried E.Silverstein,MD et al. Gastrointestinal toxicity with Celecoxib vs Non-steroidal Antinflammatory Drugs for Osteoarthritis and Rheumatoid Arthritis.2000.JAMA;284(10):1247-1255. 18. Anders and Vielhauer. Renal co-morbidity in patients with rheumatic diseases. Arthritis Research & Therapy.2011, 13:222. 19. Whelton A. Nephrotoxicity of nonsteroidal anti-inflammatory drugs: physiologic foundations and clinical implications.Am J Med 1999,106:13S-24S. 20. Horl WH: Nonsteroidal anti-inflammatory drugs and the kidney. Pharmaceuticals 2010,3:2291-2321.Abstract
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