A longitudinal study of serum creatinine levels in patients of rheumatoid arthritis on long term NSAID therapy.

AIM: Primary: To study the effect of long term NSAID therapy on serum creatinine in patients of rheumatoid arthritis. Secondary: To study the effect of discontinuation, reduction in the dose or continuation of NSAID and of rechallenge. MATERIAL AND METHODS: Case records of RA patients with a minimum two years of follow up were analysed. Age, sex, duration of RA, type, dose and duration of NSAID and DMARD therapy, co-morbid conditions and serial serum creatinine levels were charted. RESULTS: Ninety nine case records were studied. Incidence of abnormal creatinine level (renal insufficiency) defined as rise in creatinine equal to or above the upper limit of normal was 27.7%. This rise was asymptomatic in all patients. No NSAID was particularly associated with an increased risk in renal insufficiency. The rise of serum creatinine was reversible in most patients irrespective of discontinuation or continuation of NSAID but settled at a higher level. Rechallenge resulted in rise of serum creatinine in 50% patients. Hypertension, DM, IHD and diuretics carried a higher but not statistically significant risk of renal insufficiency. CONCLUSION: NSAID-induced asymptomatic rise of creatinine in patients of RA on long term NSAIDs is common. It is mostly reversible. Regular monitoring of serum creatinine is essential.

Ultrasonography in the diagnosis and follow-up of idiopathic inflammatory myopathies--a preliminary study.

OBJECTIVE: To study the utility of ultrasonography (US) in diagnosis and follow up of patients with idiopathic inflammatory myopathy (IIM). METHODS: High-resolution US of thigh muscles was recorded at baseline and after six months of treatment in eleven patients of early, active, untreated IIM. Parameters studied were muscle power, timed function tests (TFT), muscle enzymes, electromyography, muscle histopathology and US parameters such as echogenicity of muscle and perimysial septa count per 1 cm muscle width. RESULTS: There was a significant increase in muscle echogenicity and septa count of patients as compared to those of controls (p = 0.002 and 0.00003, respectively). These abnormalities resolved on treatment. Muscle echogenicity and perimysial septa count showed mild positive correlation with walking time, 4-step climbing and myopathic pattern on EMG. Perimysial septa count in addition correlated weakly with creatine phosphokinase, lactate dehydrogenase and muscle fibre necrosis. CONCLUSION: US seems to be a useful, non-invasive, cheap modality to monitor the disease course in IIM. Larger studies to confirm these primary findings are warranted.