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NEWS AND VIEWS Table of Contents   
Year : 2002  |  Volume : 36  |  Issue : 1  |  Page : 61
Treatment of chronic arthritis: Selective NSAIDs are not necessarily non­-nephrotoxic


Department of Nephrology, All India Institute of Medical Sciences, New Delhi, India

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How to cite this article:
Bhowmik D, Tiwari SC. Treatment of chronic arthritis: Selective NSAIDs are not necessarily non­-nephrotoxic. Indian J Orthop 2002;36:61

How to cite this URL:
Bhowmik D, Tiwari SC. Treatment of chronic arthritis: Selective NSAIDs are not necessarily non­-nephrotoxic. Indian J Orthop [serial online] 2002 [cited 2019 Oct 16];36:61. Available from: http://www.ijoonline.com/text.asp?2002/36/1/61/35935
Treatment of chronic arthritis is a common problem in orthopedics. Until recently non-selective NSAIDs viz. diclofenac and naproxen were commonly used. These drugs had attendant gastrointestinal and renal side effects. Selective NSAIDs viz. nimesulide, celecoxib, rofecoxib and meloxicam are now available for clinical use. Celecoxib and rofecoxib are approved by FDA for the treatment of patients with osteoarthritis and rheumatoid arthritis. From the gastrointestinal point of view they are definitely safer. [1] However the same cannot be said of their renal side effects.

The role of COX-2 becomes increasingly important in the elderly and in patients with dehydration, chronic renal impairment, diabetes, heart failure and liver disease. COX-2 inhibition in these patients is likely to cause acute deterioration of renal functions. Reports to this effect are now available. [2] Hence wherever possible it would be safer to avoid NSAIDs (both selective and non­selective) and instead use paracetamol or dextropropoxyphene (in severe cases). If it is a must to use selective NSAIDs the following precautions would definitely be helpful.- use the least possible dose for a short period of time with regular monitoring of renal functions. If deterioration of renal function occurs they should be stopped immediately. These measures would help in avoiding the morbidity and mortality associated with acute renal failure following use of selective NSAIDs in high risk cases.

 
   References Top

1.Bombardier C, Laine L, Reicin A, et al. Comparison of upper gastrointestinal toxicity of rofecoxib and naproxen in patients with rheumatoid arthritis. N Eng J Med 2000;343: 1520­1528.  Back to cited text no. 1    
2.Perazelia MA, Jennifer E. Are selective COX-2 inhibitors nephrotoxic? Am J Kidney Dis 2000; 35: 937-940.  Back to cited text no. 2    

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Correspondence Address:
Dipankar Bhowmik
Department of Nephrology, All India Institute of Medical Sciences, New Delhi
India
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Source of Support: None, Conflict of Interest: None


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