Rheumatoid arthritis (RA) most commonly affects the joints of the small bones of the hands, as well as the lining of joints throughout the body. Affected joints will become painful, red, and swollen, and ongoing inflammation may cause joint deformation and damage over time.
Because RA is a systemic and progressive disease, it can cause inflammation in major organs, including the kidneys. The effects of RA on your kidneys can be far-reaching and sometimes fatal. Here's what you need to know about the effects of RA on your kidneys, as well as what you can do to lower your risk of kidney problems.
The precise relationship between chronic inflammation and CKD in people with RA is not always clear, but researchers believe certain inflammatory proteins play a role. This means that the more severe your RA the more likely you are to develop kidney problems.
Uncontrolled inflammation can harm the kidney linings and lead to atherosclerosis, a condition in which plaque accumulates on the inside of the renal arteries (the arteries of the kidneys).
Plaque buildup causes hardening and narrowing of the arteries and blood vessels over time, reducing blood flow to the kidneys and eventually causing the affected kidneys to fail.
A 2016 study published in the journal PLoS One looked at the relationship between C-reactive protein inflammatory markers and the prevalence of CKD in people with RA. In this study, researchers discovered that high CRP levels were a significant risk factor for CKD and that persistent inflammation increased the risk of CKD in people with RA.
Another study, published in The Journal of Rheumatology in 2011, investigated the effects of cystatin C, an important biomarker of renal function. Researchers discovered cystatin C to be elevated in people with RA, particularly those with high levels of inflammation.
High cystatin concentrations are thought to be indicators of undiagnosed kidney dysfunction. They are also linked to an increased risk of atherosclerosis in people with RA, both renal and cardiovascular.
Amyloidosis is another potential kidney concern for people with RA, particularly those with long-standing and poorly controlled RA. Amyloidosis is characterized by abnormal accumulation of the protein amyloid in organs. The disease causes amyloid to build up in the kidneys of people with RA.
Heart problems can also contribute to the development of kidney disease in RA patients. This is because people with RA are more likely to have high blood pressure and other risk factors for cardiovascular disease (heart disease).
This increased risk is linked to inflammation, cardiovascular disease, and renal toxicity from RA medications. If you have RA, it’s also essential to visit a kidney doctor on a regular basis.
The majority of the RA medications prescribed by your doctor have no direct effect on your kidneys. Nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, methotrexate, and cyclosporine, on the other hand, can increase the risk of decreased kidney function.
Kidney damage from NSAID use is uncommon in most healthy people. 9 Taking higher doses of NSAIDs to manage pain and inflammation, on the other hand, may result in NSAID nephrotoxicity—the rapid deterioration of the kidneys caused by the toxic effects of NSAIDs.
Frequent use of NSAIDs, as well as other acetaminophen-containing pain relievers, can also result in nephropathy. This condition indicates that the small blood vessels in the kidneys that clean the blood have been damaged.
If you are concerned about the number of NSAIDs you are taking to manage pain and inflammation, consult your doctor. They can assist you in locating alternative pain relief options.
While corticosteroids do not cause direct kidney damage, they can cause fluid retention, which raises blood pressure. Continued use of corticosteroids, can aggravate existing kidney issues or lead to kidney problems.
Methotrexate is the most effective RA treatment available, and it is frequently the first drug that doctors prescribe. It can alleviate symptoms such as joint pain, fatigue, stiffness, and swelling, as well as reduce inflammation and prevent joint damage.
Methotrexate is excreted by the kidneys. High doses of methotrexate may cause a buildup of the drug in the bloodstream, potentially leading to an overdose. According to research, at least 1.8% of methotrexate users have kidney dysfunction.
Cyclosporine is a strong immunosuppressant that can impair kidney function. Most people who develop kidney dysfunction while taking cyclosporine have been taking it for a long time and at high doses.
Fortunately, most cyclosporine-related kidney problems are minor and can be resolved by adjusting the dosage or discontinuing the medication.