26th June 2023

A 50-year-old female has a long history of rheumatoid arthritis and has had multiple treatments to manage her symptoms.

A 50-year-old female has a long history of rheumatoid arthritis and has had multiple treatments to manage her symptoms. She was originally started on methotrexate, but this had little effect, and there was little improvement with hydroxychloroquine. She was then started on injections into her gluteal muscle, which she was having once a month up until two weeks ago, and these have managed her symptoms well for the last three years, but the rheumatologist has stopped them due to concerns about her renal function.

She has been referred to the renal clinic with a slowly declining renal function and leukocyturia. She also mentions increased lethargy but says this is quite common for her due to her rheumatoid arthritis.

What is causing the patient’s renal function to deteriorate?

Select the SINGLE most appropriate option from the list below. Select ONE option only.