The nephrotoxicity of methotrexate (MTX) is a phenomenon which is observed in high-dose therapy for treatment of malignant diseases. Even low-dose MTX therapy for treatment of rheumatic diseases is claimed to cause impairment in renal function. The necessity to adapt the dosage of MTX therapy for renal function disorders due to other causes however has first priority. The following article describes why nephrotoxicity of low-dose MTX has no clinical relevance and why in contrast non-steroidal anti-rheumatic drugs (NSARDs) are a problematic nephrotoxic group of substances and a long-term elimination from the therapeutic armamentarium for rheumatoid arthritis (RA) should be instigated.