What are the Anti-Rheumatic Drug Prescribing Patterns in Rheumatoid Arthritis Patients With Chronic Kidney Disease?: A Single-Center Cross-Sectional Study

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Aim: This study evaluated the distribution of anti-rheumatic drug treatments in rheumatoid arthritis (RA) patients with chronic kidney disease (CKD) across different renal stages. Material and Method: A cross-sectional analysis included 72 RA patients with CKD (estimated glomerular filtration rate 3 months). Demographic characteristics, disease duration, laboratory results, current RA medications, and renal replacement therapy status were recorded. Additionally, the presence of extra-articular manifestations, comorbidities (including hypertension, diabetes mellitus, hyperlipidemia, coronary artery disease, cerebrovascular disease, osteoporosis, and malignancy were obtained from the electronic patient files), history of prior infections, underlying etiology of CKD, and availability of renal biopsy reports were retrospectively extracted from hospital electronic medical records. Patients were stratified by CKD renal stage (3, 4, 5). Results: Mean age was 66.7±11.8 years; 73.6% were female. Hypertension (84.7%) and diabetes (33.3%) were prevalent comorbidities. CKD etiology was undetermined in 65% of patients. Overall, 97.2% received conventional synthetic disease-modifying antirheumatic drugs (csDMARDs), 12.5% biologic disease-modifying antirheumatic drugs (bDMARDs), and 51.4% glucocorticoids. Hydroxychloroquine was the most common csDMARDs (76.4%), while methotrexate use differed significantly by CKD renal stage (stage 3: 27.7%; stage 4: 9.1%; stage 5: 0%; p=0.028). Among bDMARDs, rituximab (stage 3 only), TNF inhibitors (all stages), and tocilizumab (stage 4) were used. Etanercept was preferred in dialysis-dependent patients. Conclusion: CKD stage significantly influences RA treatment selection. Methotrexate is avoided in stage 5 CKD, while hydroxychloroquine remains the predominant csDMARD. Leflunomide and sulfasalazine use in advanced CKD exceeds prior reports. Individualized therapy, adjusted for renal function and comorbidities, is essential. Larger prospective studies are needed to validate these findings.

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