stopping methotrexate due to liver enzymes

[Phillylou]

hi all , I’ve got Psoriatic Arthritis ( as well as O.A.) and I’ve been on methotrexate injections for 6 years. Also amgevita for the last 18 months.

my blood work is showing my liver enzymes hitting the roof 126, then taking a couple of months to return to mid 60’s , then hitting the 90’s again.

my gp recommends stopping methotrexate , I’m waiting on a reply from my rheumy.

has anyone had to stop methotrexate due to this side effect and was there a replacement offered.

look forward to replies please xx

[Greenmil3]

hi my GP has written to my Rheumy about by liver function and asked me to do the same as he said my last 2 blood tests where the same. Unfortunately I have brain damage and can’t remember what my GP and I spoke about so hand to call my Rheumy nurse Monday to see if it indicates damage due to the MTX. Let you know if I have to stop

[Waffs]

Hi like you I have been on methotrexate for a few years but had some issues last year with coughing up blood. After various tests was eventually diagnosed with liver fibrosis, my rheumy immediately told me to stop taking the methotrexate! Apparently on my paperwork it states Liver fibrosis probably due to methotrexate. I also take Idacio injections and there was no replacement for the methotrexate. Unfortunately I have been unable to take the injections for the last 12 weeks due to some prostate and bladder issues and have had surgery to see what's going on. Hope you are ok and that any further prognosis for you is good. All the best.

[Lulla]

sorry to hear you are experiencing this. I think I’m in the same boat, except that my rheumatologist started me on methotrexate when my liver numbers were already high. I have my second appointment next week and will try to get some answers. And hopefully will be taken off mtx and offered something else.

I heard that before being prescribed something else we kind of have to try mtx first (cheap and widely available) and then if there are issues / is not effective, we can be put on something else.

[hazmatrec]

hiya! I wasgiven methotrexate to try and deal with some skin problems. my liver ALT test went up to about 500 tho, so, ziiiip, had to come away from that. this was before I had any arthritis diagnosis, altho not before being symptomatic. I was then given leflunomide last year with a tentative rheumatoid arthritis diagnosis. liver did okay, but it didn't really help much. but that's changed now, to psoriatic arthritis, which makes more sense (includes the cauda equina etc). I've now been prescribed adalimumab. I'm on a bit of a watch because my alt doubled in two weeks and my white blood cell count is lower than they want it to be. I'm hoping the numbers stay okay enough to stay on it, because I'm feeling some shifts in inflammation levels. but there are still more options even if adalimumab isn't the one.

[Lulla in reply to hazmatrec]

My ALT doubled after one month of methotrexate . As did AST and GGT.

Sorry can I ask what you mean about the cauda equina? How is yours affected? I’m asking because one of my symptoms on waking is lower back pain. Goes away after about 5 minutes moving around.

I wonder what would be considered a safe level of elevated liver numbers. Before they take you off medications.

[hazmatrec in reply to Lulla]

hello! my alt was 99 this past blood test, and I haven't had the follow up number yet. they didn't take me off, just had me hold off till after. I would think each situation would have its own tipping point, like, I've had raised liver since I started any medicine so they keep a close eye, but expect a bit of raise any time i start something new. also, each lab has their own test range numbers, so numbers might have different meanings. definitely ask! what I meant about cauda equina: psoriatic arthritis , i think the number was 40% of folks with PsA will also deal with sacroiliitis or spondylitis (Wikipedia, I just checked) . I've got vertebrae making extra bone and I've had a sticky outty tummy since I was little, but this past December, I had one section of my lower back so out of whack that it was squashing all the nerves and I lost most sensation. I had spinal surgery for the emergency bit and there are two more places still crowded but I'm trying to muscle those better. the squashed nerve bit, it's called cauda equina syndrome.

[Lulla]

thank you for your reply. Unfortunately I have learned what cauda equina is because my daughter has arachnoiditis and her cauda equina nerves, as well as others, are clumped. Stuck together due to scarring rather than pressed on by an out of line spine. But that’s another story.

I was wondering about possible causes of back pain that is linked to Psa and I was not aware of the sacroilitis and spondylitis. PsA seems to be quite the pathology!! Lucky us! 😔