Renal or gastrointestinal involvement in rheumatoid arthritis is most commonly due to which factor?

• A. Methotrexate
• B. Biologic DMARDs
• C. Hydroxychloroquine
• D. NSAIDs

Answer: (D)

The main idea is that NSAIDs are the drugs most commonly linked to renal and gastrointestinal problems in rheumatoid arthritis. NSAIDs work by inhibiting cyclooxygenase enzymes, which lowers prostaglandin synthesis. Prostaglandins help protect the stomach lining and maintain blood flow to the kidneys. When their production is reduced, the gastric mucosa becomes more susceptible to irritation, ulcers, and bleeding, and renal perfusion can drop, risking acute kidney injury or chronic kidney damage, especially in those who are dehydrated or have existing kidney disease. Other drugs used in RA—like methotrexate, biologic DMARDs, or hydroxychloroquine—have different risk profiles and aren’t typically associated with renal or GI injury as a primary feature. So NSAIDs best explain the renal and GI involvement seen in RA.