Hi warriors 👋
My latest blood test (liver function) have shown as abnormal again.. I'm going to phone rheumy on Monday but wondered if any of you have had similar results?
In November 21 they were high but still climbing. Seems to be since I started biologics last year.
Yes It only happened once yo me , think I stopped biologics for a short period then changed to another one xx good luck . Let us know what they say
Thanks Allanah I will x
Hi, my readings were always fine until I started on tofacitinib. Now they're always awry. My alt, ast and ggt are about double the normal range. I got phoned by my gp to ask if I drink too much...twice! I had a liver scan which was normal but showed some fatty liver changes. I'm also waiting to see my rheumatologist again. Can I ask what biologic you're on? Mine says in the leaflet it can cause abnormal liver enzymes.
Hi Love2camp,I've been on adalimumab (amgevita) since about June last year. I don't drink alcohol at all. Can you remember how high your enzymes were? X
I've just had a look at my last test. AST 47 (0-32)
ALT 66 (0-32)
GGT 123 (7-32)
Alkaline phosphate 115 (35-105)
I was advised that they see readings much much higher than this and not to worry but it's always good to know it's being checked out. My GP said the rheumatologist is the person who needs to decide if anything needs investigating as it's medication related.
Like you mine have risen gradually since introducing biologic. Hope you can get some advice and please share if you do x
I will do luvvy thanks 💜
When I was on Azathioprine I had raised levels, which were over double the upper limit. I’d been fine on it for 3yr, then they needed to increase dose from 150 to 200mg, and that threw my levels out. I had to stop the Aza, and have an ultrasound of my liver which found no issues, and they returned to normal fairly quickly after stopping. I was then changed to methotrexate and been on that with no issue for 5yr. You may just need a short break, if it reoccurs they would probably change your biologic.
I do have gallstones (for years I think) so I'm wondering if that's causing the issue?
Sounds like you're doing the right thing, being aware, keeping being monitored & asking for answers. Really hope things settle 
even if it means a different biologic. Like allanah said - will be good if you give feedback on here 😁. Good luck!
Thanks Blodyhaul, I check my blood results on the nhs app now to catch things early. My rheumy team usually phone me if there's anything abnormal but if they don't I'll phone them. I'll update on here 💜
That app sounds worth using! I must look into it - thanks E.Rose😁
You're welcome Blodynhaul.. if you can't view all your results etc just a quick phone call to your gp and they'll update it for you.
Thanks 'Rose', I phoned my surgery as when I tried to register online it said my surgery won't do that. But surgery now sent me email so I can register, so that's good. Thanks for mentioning it X
Hello mine are up all the time and I’m only on sulphasalazine, I was told all RA drugs are heavy on our liver? I also had liver scan, all ok. It’s good we have the blood tests to keep an eye on us. But if I’m asked if I drink alcohol again I will scream, as i don’t normally ! Although lately I may have a small glass of red once a week, just helps me deal with the stress of it all. So tough not to be able to have a little drink now and again x
Oh I love most alcohol.. but it doesn't like me lol. Stopped drinking any about 2 years ago 😪 I really wanted to pig out on Baileys at Christmas but didn't bother in the end xx
Was on MTX for about 13 years. Before that I loved drinking alcohol, but stopped pretty soon after starting MTX as felt so sick & also reduced its efficacy. Still can't believe 16 or 17 years s8nce I stopped alcohol! though nowadays I have about a handful of drinks a year& wondering about having a little more again..! (on a Jak now)
My alt etc went through the roof when on mtx so I had to stop it. As others have said maybe a change of meds might be in order. It always drive me mad that I was constantly asked how much alcohol I drank I don’t drink at all and was far too unwell and nauseous to even think about it.
They've taken me off mtx, I think if my liver enzymes drop it should be OK just on biologics, fingers crossed 🤞
Having had problems last year and again at the moment, my understanding is that the general rule of thumb is any elevation of ALT and/or AST more than 3 times the upper limit of normal requires RD meds to be stopped. Anything below 3 times the ULN is usually a wait and watch approach with fortnightly bloods, as unless there are underlying liver issues, liver enzymes can be safely left elevated as long as they’re stable. It’s an aside, but 3 times the upper limit is actually considered a mild elevation; you can get ALT readings of several thousand in some liver conditions.
If the levels quickly come down, then the options are to potentially restart on a reduced dose depending on the med, or consider switching to something else. I was fine on 25mg subcut mtx and 15mg leflunomide together, but it wasn’t working so they decided to bin the mtx and increase the lef to 20 en route to adding in sulfa; within a fortnight of the lef increase, my ALT was over 100. Reduced the dose back down, only for it to be 160+ a fortnight after that. Was told to stop the lef completely, but for whatever reason my levels were still out of whack above 3x ULN for months, so I got referred to hepatology for a fibroscan and further tests. Long story short, after 6 months, and having been forced off all sorts of meds (not just my RD ones), hep cleared me and I was put on imraldi in September. Hasn’t worked at all, so in December they decided to reintroduce lef at the lowest dose on alternate days, and within a month I was back up over 100 for my ALT again 🙄 I’m in clinic next week to discuss, but they’re reluctant to bin the lef completely because they’re limited on biologic options as a result of my diagnosis being psoriatic arthritis rather than RA; if we stop the lef, we’ll have to stop the imraldi because we already know it doesn’t work on its own. Interestingly, though, I had a hep review last week, and although she’s now discharged me, she’s said she doesn’t want my ALT going much over 100 due to my history, and is writing to rheum to tell them that. They won’t be happy about it, I don’t think.
Anyway. Point of the ramble was mostly to say been there, done that, still doing it.
Oh the joys! Bless ya. Obviously my alt aren't anything to worry about then if they're only slightly raised. Phew! I was thinking all sorts of things. I was googling and one minute it's fine and the next minute I'm dying 😂
Hope you get sorted soon 👍 🙏
When I was on sulfasalazine and mine showed over 100 I got a call from Rheumy nurses . Came off it but My alt kept climbing went up to 1556 had to have scans on all my organs and eyes and had to come off all medication until the liver was back to normal .
Jeez that's high. Glad they're back to normal for you ❤
Yes - my LFTs went up a lot during a period last year . I had the usual "drink" questions - I do , but rarely , perhaps a couple of glasses in a month .
My ALP has always been high but went even higher , also my GGT . I had a liver scan and all was fine .
In the end it was decided that paracetemol could be to blame . I'd had a fall and sustained "deep tissue injury" ( no broken bones ) and I was taking the full amount , at correct intervals . It was thought that this could have put extra pressure on my already highly medicated ( with RA drugs ) liver .
I read somewhere that this had happened to someone in hospital on intravenous paracetemol
The levels finally came down but are often just above the suggested range . As for my CRP , it goes up and down like a yo-yo , for no apparent reason . RA is a curious disease 🤔
Yep it's a curious disease. My mum suffered badly and it scares me to think I'll be as bad as she was, that's why I keep an eye on my bloods now.
I've stopped a few drugs to give my stomach and liver a rest to be honest.. paracetamol, ibuprofen, hrt (kliovance) and even cocodamol. I'd like to come of prozac but I think that needs to done slowly.
When I had shingles , ( not allowed to have the vaccine as it’s live - because of RA and drugs ) I was given amitriptyline for the pain .
When I recovered from shingles my rheumatologist suggested I continued with this drug as it was good for RA pain .
Some years ago , when I was hospitalised for my TKR , I asked if I could have separate pills of codeine and paracetamol , so that I could juggle the amount of the separate pain killers , as needed , rather than take cocodamal in one pill .
I have found this very useful as I can now take paracetamol on its own , or with codeine or with amitriptyline depending on my pain level .
Amitriptyline is great for helping you to sleep but should not be taken in combination with codeine.
I was tempted to ask my gp for amitriptyline, I was on them a few years ago. They do make me sleepy so I've never tried them in the day time..
I take Amitryptiline at 7pm. I sleep really well, and it has really helped with pain relief. So has taking medical retirement! Looking back I think a lot of my pain was rooted in stress.
I was finished from work last year through ill health and yep stress was getting to me. It was a physical job also. I'm going to ask for amitriptyline, thanks CripLady.
It took me about a year to feel settled. ‘Medically retired’ is a huge relief and weirdly gives us a category. Take care x
You take care too xx
HiI have no experience of Biologics, I’m on 20mg Mthx and my liver was always elevated until I swapped 40mg of Omeprazol to 15mg of Lansaprozal for my tummy acid, the difference has been staggering, I’m now under 20 ALT. Do you take any PPI’s - just a thought?
x
Hi, I take lansoprazole when I can feel the burning acidic sensation in my abdomen. I've been worried about taking it daily, but I suppose prevention is better than cure?
Blood test results - best practice
Awaiting bloods , xray results / diagnosis
Blood results and first rheumatology appointment 
Who checks the blood test results?
Blood results
