Dr. Ajeet Singh (General Practice) needs a second opinion on this medical case.
A 45 year old female housewife by occupation *Chief Complaints* Pain in legs Dysuria Brown coloured urine Decreased urine output than before She is experiencing these symptoms for past 5 days and she has stopped all her RA drugs too *History* Known case of HTN with CKD with RA with Hyperuricemia She was on - Leflulonamide 20 Methotrexate 7.5 weekly HCQ 200mg BD Folic Acid 5mg OD She stopped all these drugs thinking of drugs being cause of urine colour change and infection *Vitals* BP 150/90 Pulse 90 *Investigations* Ordered investigations - Urine R,M,CS S Urea, S Cr S Uric Acid *Management* My concerns - 1) Safest anti hypertensives that can be given in this case of hyperuricemia with CKD with RA ? 2) Is any drug of RA a culprit for her urinary tract problem that she is facing? 3) Can't sulphasalazine could be given before thinking about HCQ or Leflulonamide? Thank you
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