To estimate effectiveness of ambulatory treatment of gouty arthritis (GA) using non-steroidal anti-inflammatory agents (NAIA) and detect factors associated with the impairment of the functional state of kidneys during short-term therapy.
The functional state of kidneys in 100 patients with GA was estimated from creatinine clearance (CC) calculated by the Cockroft-Gault formula on day 2 after their examination in a polyclinic and prescription of NAIA to stop the gout attack or during the first days after hospitalization. Mean duration of NAIA therapy was 10.8 ± 4. 77 days.
18% of the outpatients with CC < 60 ml/min were given high doses of NAIA, 47% patients received them during the entire period of treatment, 36% were prescribed combined therapy with two or more NAIA. A short course of NAIA therapy resulted in the enhancement of CC in 46% of the patients and its fall in 54%. In 1 patient CC decreased by more than 50% compared with initial level; in 12 patients the decrease exceeded 25%. The risk of CC reduction under effect of NAIA increased in case of high NAIA doses (OR = 1.52, 95% CI 1.05 = 2.20, p = 0.024), combination of several NAIA (OR = 2.74, 95% CI 1:95-3.87, p = 0.02), concomitant infection and antibiotic therapy (OR = 11.51, 95% CI 8.76-15.13, p = 0.005), II-III NYHA FC chronic cardiac insufficiency (CCI) (OR =4.88, 95% CI 9.83-1681, p = 0.019).
Physicians of outpatient facilities do not always take account of the functional state of kidneys when prescribing NAIA for the treatment of GA. Kidney conditions in such patients deteriorate in case of high NAIA doses or combination of two and more NAIA during the entire period of therapy, in the presence of infection requiring antibiotic therapy or CCI.