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A slur is any insulting or disparaging remark. The r-word used as a way to make fun or tear down any individual is a slur. It hasn’t even been used as a medical term for decades now. It doesn’t matter the company you keep or if the recipient of said remark is “okay” with it. It’s a slur and has been distasteful for a long time.
Technically, one of the things that makes it worse - some of the folks I used to work with still had MR as their official medical diagnosis - less than a decade ago, and since most of them were young enough to probably be still alive, they still have it.