Renal Manifestations of Rheumatoid Arthritis

Renal manifestations in rheumatoid arthritis (RA) have evolved as RA management has improved. In the past, older disease-modifying antirheumatic drugs, uncontrolled systemic inflammation, and chronic nonsteroidal antiinflammatory drug (NSAID) use contributed to kidney disease. Over time, the use of methotrexate and biologic medications, decrease in NSAID use, and a treat-to-target strategy have contributed to a decrease in renal manifestations. Chronic kidney disease in RA now is more likely to be caused by cardiovascular risk factors than uncontrolled RA disease severity. In patients with renal dysfunction, NSAIDs, methotrexate, and tofacitinib may need to be adjusted or avoided to prevent adverse events.