Routine laboratory monitoring of children with juvenile idiopathic arthritis who take nonsteroidal anti-inflammatory medications has limited clinical utility and most likely is not cost effective, a medical records review suggests.
The records of 91 children who were diagnosed with JIA, treated with an NSAID for at least 1 month, and followed in a pediatric rheumatology clinic between January 1996 and September 2006 were reviewed for the results of laboratory monitoring of hemoglobin, transaminases, blood urea nitrogen, serum creatinine, and urinalysis, as well as for clinically significant NSAID-related effects.
Laboratory abnormalities were recorded for 24 of the 91 patients included in the study, but nearly all were mild and were not associated with clinical sequelae, said Dr. Sheetal S. Vora of the Medical College of Wisconsin, Milwaukee.
Of the 62 patients with oligoarticular disease, abnormalities included low hemoglobin in 5, elevated serum transaminases in 7, elevated BUN in 9, and trace proteinuria in 1. Five had abnormalities in two categories, and one of these patients discontinued NSAIDs.
Of the 29 patients with polyarticular disease, abnormalities included low hemoglobin in 5, elevated BUN in 1, and trace proteinuria in 1; none of these patients had more than one abnormality recorded, and none discontinued NSAID treatment, the investigators found (Pediatr. Rheumatol. 2010;8:11).
The frequency of testing varied widely in the patients studied, with frequency ranging from 0 to 17 times per patient for serum AST, and from 0 to 14 times per patient for serum ALT, for example.
The median frequency of most tests was 1 or 2, except urinalysis, which had a median frequency of 0 tests per patient. The median duration of NSAID treatment was 12 months, and all patients were treated with only one NSAID at a time (most often naproxen). Few patients received any additional medications, the investigators noted.
Although many physicians perform routine laboratory monitoring in children with JIA who are treated with NSAIDS, there are no consensus evidence-based guidelines regarding this practice.
Based on the findings of this study, it appears that such monitoring is unwarranted, they said.
“Our study suggests that clinically significant adverse events requiring the cessation of NSAIDs and detected by routine laboratory monitoring appear to be very infrequent. A prospective study to determine the incidence and prevalence of significant NSAID-related adverse effects detected by routine serial laboratory monitoring in children with JIA would be helpful for better defining the value of routine laboratory testing.
Disclosures: The authors declared that they had no conflicts of interest.