Renal toxicity associated with disease-modifying antirheumatic drugs used for the treatment of rheumatoid arthritis.
OBJECTIVE
To provide a review of the renal toxicity of disease-modifying antirheumatic drugs (DMARDs) currently used for the treatment of rheumatoid arthritis.


METHODS
Papers in American and European medical journals related to renal toxicity of DMARDs used for the treatment of rheumatoid arthritis were reviewed. Specific DMARDs reviewed were cyclosporine, gold, D-penicillamine, methotrexate, azathioprine, antimalarials, sulfasalazine, leflunomide, etanercept, infliximab, and DMARD combination therapy.


RESULTS
The renal toxicity of DMARDs varies widely. Cyclosporine, gold, and D-penicillamine all have a serious potential for renal side effects, particularly in the elderly or in patients with compromised renal function. Concomitant use of nonsteroidal anti-inflammatory drugs (NSAIDs) increases the potential for renal damage. In contrast, methotrexate, azathioprine, antimalarials, sulfasalazine, leflunomide, etanercept, and infliximab have relatively little renal toxicity.


CONCLUSIONS
The potential for renal toxicity should always be considered when determining which DMARD to use for RA therapy. DMARDs that combine efficacy with negligible renal adverse effects should be used for the treatment of patients susceptible to DMARD-associated renal damage.
Schiff
M H
MH
University of Colorado School of Medicine, Denver, CO, USA. lmschiff@aol.com
Whelton
A
A
D018501:Antirheumatic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy; D016572:Cyclosporine / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D007668:Kidney / Q000187:drug effects*; D050607:Organogold Compounds; D010396:Penicillamine / Q000009:adverse effects / Q000627:therapeutic use
D018501:Antirheumatic Agents; D050607:Organogold Compounds; D016572:Cyclosporine; D010396:Penicillamine