Liver Enzymes and RA Advice

I was diagnosed with seronegative RA in March of this year. I have also been plagued since 2002 with elevated liver enzymes, which of course limits the drugs that I can use for the RA. My rheumatologist tells me to limit my eating of carbohydrates to help the liver and to learn to deal with the RA problems because sulfasalazine is the only thing I can use at this point for the RA. I am doing my best to comply, but was wondering if any of you have any practical advice to add, since you understand better than anyone what this entails. Thank you. Deb

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12 Replies

  • Hello how severe is the r/a Deb? The sulfasalzine might be enough for you

  • Hi, you must be feeling so unwell just now

    My liver always kicks up a stink with some of the drugs I take and when I was on MTX the situation became intolerable

    Is it possible you are taking a lot of pain killers? Also I now limit the alcohol I take as this also raises my enzymes.

    That is all I do...hope you can find an answer...I felt so much better once my levels were back to a more normal state


  • No alcohol and limiting the amount of paracetemol that I take was the only thing that made a difference to this reading. I'm on Arava [couldn't tolerate Supha and came to the end of the road with Mtx after 10 years] which says 'no alcohol' very strictly on the label.

    Cece x

  • Thank you so much Cece and Poppylady. I have never been one to use much alcohol and since the liver problem popped up, I don't drink at all or take any Tylenol. All I use is the occasional naproxen when I feel I can't deal with the back pain. I have been drinking a nice herbal tea that helps the liver detox a bit and it seems to make me feel a little better. Thank you for the suggestions.

  • When I first was diagnosed my liver wasn't very happy at all, it was in a bad place so I was put on sulfa same as you. I was so bad on it, vomiting etc I couldn't take it. So I stopped drinking and changed my diet (sort of!) and a year later I was able to go on MTX. Luckily my liver is coping well...although having a rest from it at moment due to other side effects....I do take quite a lot of painkillers but still my liver is hanging on in there....perhaps I am one of the lucky ones regarding the liver but I never drink now (except Christmas Day!). And I really think that helps me...this may not be your case...have you spoken to your GP in detail about this...I have found my GP is far more approachable than the consultants and he knows me better than they do. I see him every week he really is helpful...try yours and explain to him your worries. I hope he is a good doctor because you'll probably get more from him/her. I send you a smile pass it on its free and travels really well. Maryx

  • Thank you for your response, Mary. I am glad for you that your liver is coping better these days. I am not sure why mine seems to have a problem, as I never drank very much, and now I don't drink at all. My GP was first to notice the liver problem as it showed up a good 10 yrs before the RA did. I am in the U.S., so our medical customs are a bit different than yours. My GP referred me to a dr who did a liver biopsy and nothing was found from that test. Now with RA, I go to the Rheumy doc once every 3 months and he is the one who requires the blood work----The GP I only see once every 6 months for his input. No one seems to know what else to do about the liver issue except to tell me to watch the carbs and lose weight if I can.

  • Hi Deb, I know your original post is now two years old, but I'm wondering if you could give me an update. This is my problem lately. My liver enzymes have been elevated for most of the last year. I have reduced but not eliminated MTX (down to 4 tabs starting this week) and I have reduced but not eliminated alcohol (had about 5 glasses of wine over the holidays but nothing at all between late November and December 23). Not sure what my current levels are, but I am wondering if there is a thyroid connection...

  • My PC checks my thyroid every year and so far it appears to be functioning normally according to the blood work. My liver is still struggling and given the recent onset of horrible heartburn, my rheumatologist took me off the sulfasalazine and put me on a drug called Azathioprine. He said in addition to the RA, it might help the liver problem. I believe it is given to people with autoimmune hepatitis. It's still too early to tell if it's helping anything as it can take 3 months to kick in, but I can say for sure that the sulfasalazine was definitely helping my pain levels, as without it, I'm struggling. I've never taken MTX because the rheumy said no, not with a liver issue so it's good that you are cutting it out. And of course, the alcohol must go, I'm sad to say. I sure used to enjoy an occasional glass of wine. Thanks for asking about me and good luck to you. It will be interesting to see what your next blood draw shows. Keep me posted, please. :)

  • Thanks Deb! I appreciate your quick reply. I will let you know.

  • i was diagnosed 15 years ago with RA. Been on remicaid injections for all that time. It did seem to help control the pain. My doctor switched me to Humira 2 months ago.

    at first it seemed to work, but now I am back up to the pain level i was at when i was first diagnosed. I am now waiting on a return call from doctor to get some help/advice. RA is a real bitch !

  • I'm very interested too in this business with the liver enzymes. I've suffered raised ALT on and off since 2005 but as this was 10 years before RA and blood tests were few and far between. I'm thinking its fatty liver through years of yo yo dieting. Ultrasounds support this. My liver surface is smooth however ( apparently that's a good thing)

    Once RA raised its ugly head of course all the blood tests started in earnest and I was taken off Methotrexate after a week. Allergic to Sulfa and again the ALT went bananas on Arava ( Leflunomide)

    Currently on Hydroxychloroquine and Enbrel ( six injections in) my blood tests specifically ALT is the lowest it's been for years.

    I'm currently going crazy with my Nutribullet and haven't had a drink for a couple of weeks so I guess I'm giving my liver the best chance to be healthy but I really don't want to stop drinking.

    I know this sounds as if I am a boozer but I promise I'm not, my Rheumatologist said I could have one of those livers that is sensitive to most drugs.

    Good luck Karen77 and Dbestdeb.

    I've really enjoyed reading your experiences. Sending sympathy and am very interested in your progress.

    Best regards


  • Welcome to our little group within the group. Your story sounds a bit like mine---liver problem first came about ten years before RA. My PC requires my blood be drawn every 6 mos because of it and now the rheumy checks it every three, so the pattern is pretty clear. I did yoyo diet for many years but my ultra sounds show no fatty liver and neither did a biopsy in 2008. That being said, the few clean ALT scores have been after bouts of the flu when food consumption was little more than liquids. Based on that, I figure it is either fatty liver (because of the food) or autoimmune hepatitis (because my immune system is busy fighting flu and can't bother attacking my liver). My dr said no biologics because of the liver problem and I just came off of sulfasalazine because of wicked heartburn. I have been taking Azathioprine for almost two months now with little result. I am still hoping it will kick in and fix both problems. At any rate, I see the rheumy every 3 months for blood work and steroid shots. I'll know more then. I pretty much stopped all alcohol years ago wanting to give my liver the best chance possible. I will occasionally carry a glass of wine around with me at a holiday party just so I feel like I fit in with everyone. :). Incidentally and very sadly, my 30 year old daughter is now having the same liver issue. I really want the problem solved to give her a better chance of avoiding the whole RA/autoimmune cycle. Please keep us posted of any developments. Best of luck to you!

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