HTN with CKD with RA

She has infection of E Coli in urine with colony count >100000 and is sensitive to Nitrofurantoin, so prescribed her in BD for 7 days Meanwhile her Uric Acid is 8.8, S.Cr is 1.3 ( at upper limit of reference range) She has been on lefulonamide 20mg + HCQ 200 + MTX 7.5 before I have withdrawn MTX due to raised S.Cr and put her on Saaz 500mg H/S, HCQ 200mg H/S and Leflunomide 20mg? Kindly give your valuable opinion and check attached case below



No need to give Saaz . Leflunomide 20 mg + HCQS 200 mg alone are enough to prevent progression of Rheumatoid arthritis. With S.uric acid- 8.8 - it is advisable to add tab Febuxostat 80 mg O.D till uric acid comes to 6 mg and then reduce the dose to 40 mg . It is important to know that hyperuricaemia is also known to raise S.creatinine. So in this case to prevent progression of CKD - B.P - target should be less than 120 / 80 mm of Hg , S.uric acid should be below 6 mg . U.T.I should be controlled with nitrofurantoin till infection is over and cranberry extract + D - mannose capsules for 2 months

Valuable opinion

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To find out the cause of UTI must be in priority.. Volvo vaginitis ?? Nitrofurantoin. 100 mg.x BD.x15 days followed by 1 tab OD.x15 days. Repeat Iron mi ro & Culture. + SPA. Febuxoztate.80 mg.1 OD.x10 days followed by 40 mg 1 tab.OD.x1 month.

I am agree with @Dr. Parveen Yograj Sir and @Dr. Dineshchandra Sharma Sir, but I think HAEMOGLOBIN is vital roler of the IMMUNOLOGY section. Folic acid and Cyanocobalamine Or vit- B12 are producer of haemoglobin, so it's regular essential with dietary supplements for Rheumatoid Arthritis patients.

Thanks @Dr. Parveen Yograj Sir.

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Add Febustat 40mgm Once a day

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