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New Methotrexate user with raised ALT

Hi.

Since my last post I'm officially diagnosed with Imflamatory Arthritis and am taking folic acid 6 days a week and methotrexate- 15mg.

I'm due to take my 5th dose today but have just received a letter telling me my last Alt was 90. Although I'm to continue methotrexate for now I'm to have another blood test tomorrow and will then be reviewed.

I'm panicking!!! About what the methotrexate may have done, but also about stopping taking it as have not felt any side effects and was really hoping it was the answer!

Anyone with a similar experience? What are the chances the alt will normalise? Or what's next.

Any advice and experiences very gratefully received.

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Hi

I've had consistently high ALT scores since I started Mtx 15mg two years ago...usually in the 70s. My Rheumy team ask me to stop Mtx if the score is over 80 with repeat bloods fortnightly until the score lowers. My typical score off Mtx is mid fifties. I had a Liver scan last year and was diagnosed with Fatty Liver which explains the raised scores. I've recently started Humira and my Mtx dose has been reduced to 7.5mg. I was really hoping my scores would lower as a result...so far not so!

Paul

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P.s alcohol will raise your scores and I've been advised to abstain completely. Your scores are an indication of how hard your Liver is working. Mtx being toxic your Liver does it's best to get rid of it. It's working all the harder when you add alcohol too. That said many people tolerate Mtx and alcohol...lucky so and so's!

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Hi, it has been years since I was taking mtx. I had to stop the medication due to the side effects. I was very sick the day after taking mtx and I was only taking folic acid 1 day after.

Everyone is different and have different side effects. It is best to check with your Rheumy if you have any concerns.

Hope this helps.

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Hi I was on this drug for 2 years and I never had any side effects at all. I just did not like the tablet I had to take once a week with lots of water so I changed it and had a 6 monthly injection instead, the Methotrexate worked for me but it takes time so don’t worry about it or coming of it

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The liver is very good at healing itself, so don't worry that permanent harm has been done after 5 weeks. It may well be that your body is taking time to get accustomed to MTX, so it will normalise.

But this is why we are monitored closely, so it is caught early. 90 is not sky high, so could be a blip.

If you can't adjust to MTX then there are several other equally effective drugs. So you should find something that works for you, it just might take time.

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Thank you all very much for your replies. It means such a lot to be able to ask people who have been there and done that.

I had been extremely cautious about drinking over Xmas and new year - but maybe I'm one of those people who can't tolerate any? My last blood test was the 5th Jan so I suppose it's possible that contributed. My scores before have always been low - in the 20s so it's quite a big jump for me. I feel fine though so will keep my fingers crossed it settles.

Thanks again all 😊

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Hi I take Folic acid one every day and Methotrexate 14.5 mg. once a week. I find that having a salad the day of taking the Methotrexate helps my to feel better throughout the week. The salad helps flush out anything that that is not useful to my body. I tend to have an upset stomach if I do not eat salads around the time I take the Methotrexate. I take it on Thursdays, so I try to eat salads on Wednesdays, Thursdays and Friday, if possible. I have been taking Methotrexate since 2014. I don't want to be without it unless they find something better. I hope this will be helpful to you.

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Thank you - I've been really lucky and felt fine after taking the methotrexate- so my blood test was a bit of a shock.

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Don't panic! I've had raised ALT levels many times & they've gone back to my normal once I've reduced my MTX. In fact I can't go any higher than 17.5mg injections without my liver having a go. As you've been advised to continue on MTX they're not too worried, they'd have asked you to halt it until your blood test if it was silly high. It could be that your body is getting used to this relatively new med & will settle in a little while, it happens.

As MTX is suiting you & if your other values are improving they may reduce the dose, see what happens. You never know you may respond as well on say 12.5mg, it only took a 2.5mg reduction for me to remain on it so long, 9 years in a few months. Also, remember the liver is unique in that it's the only organ able regenerate itself so if anything's to be affected it's a positive it's the liver. It can be as little as 25% healthy material left & the liver can complete repair itself with new cells in around a month, no scar tissue. Only in liver disease such as cirrhosis can there be complications, if it continues to be battered, this is scar tissue & very difficult to reverse.

Are you drinking alcohol at all, & drinking plenty of water to help flush out the toxins of MTX & any other meds you're prescribed that are metabolized by the liver?

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Thank you! You are so good at reassuring replies!

Like many things before my diagnosis I paid very little attention to my liver! I think I vaguely knew it was good at self repair but I'm glad to be reminded there's unlikely to be irreversible damage at this point.

I did have several drinks around Xmas/new year (just before said blood test!). Still well within the weekly recommended amount but maybe a reminder to be more careful and that my tolerance for alcohol is not now good! Luckily,I'm not a big drinker! I do drink plenty of water though, especially on and after methotrexate day.

Also, I only started on daily folic acid a day or so before the test so I'm hopeful this may have helped? It's interesting to hear that a small tweak to the dose can help too. I think I'd assumed if I had a bad reaction, that was it.

Thank you again 😊

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You're welcome, thank you for your nice comment! Maybe you need to be especially careful drinking around the time you take your MTX & also when you have your drug monitoring bloods? I'm not sure if increasing your folic acid helps the liver, need to check that, but it has been proven to have a beneficial effect cardiovascular-wise.

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I’ve been on methotrexate for about a year now and just this month my ALT numbers went from 19-155, three times the normal amount. My Rheumy suggested that I decrease the methotrexate from 17.5 - 12.5 (75%). I’m to increase my weekly 5mg once per week of folic acid to 5 mg twice per week. New blood tests scheduled for next week to see if numbers decrease. I hope they do!

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Thank you - Hope it goes well for you.

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I have also been diagnosed with "inflammatory arthritis" and this is my 5th week on mtx. I have a non-alcoholic fatty liver and my alt level was not normal to begin with (I think maybe 52). I haven't had a blood test yet so after hearing your story, I hope my liver will cope!

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Hi Peep44. Well if there's one thing I'm learning it's that we all respond differently. I'll keep my fingers crossed all goes smoothly for you.

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