Liver enzymes elevated

[rue04]

Hi everyone!

I was diagnosed in 2019 and have been on mtx since then. Remicade was added in 2020 and I’m doing great on both of these meds. My most recent ALT was 129. Up from 44 which was a few months ago. Prior to starting meds my enzymes were in the teens or below. I have messaged my doctor and am waiting for a reply.

Just wondering if anyone has had any issues? Not sure which med could be causing a problem. It’s unfortunate that my enzymes are elevating because I have been in remission.

[nomoreheels]

Hiya Rue. It can happen, sometimes for no apparent reason. I've halted my MTX until the results of a repeat test were received & been able to restart it if it has returned to within my acceptable or normal range. Sometimes only a week after, other times 3 or 4. I should say I’ve been on MTX a long while now so this is my experience over many years! On the other hand it may be something which needs attention, which given the leap, makes me wonder why your Rheumy or doctor hadn't contact you prior to you taking the initiative, to give advice as they would here in the UK. I don't know if that's the case where you are but why have drug monitoring bloods only for it to be ignored if there is an inconsistency. No, they are done to keep an eye on any inconsistencies & reduce the risk of damage, or catch it early enough to act on it. Give him the benefit though, it may be on his list of things to do & you've been an early bird.

Bear in mind that other meds commonly prescribed for RD can also be the reason for hepatoxicity as they’re also metabolised in the liver, pain relief for example. So unless you're only on MTX & infliximab there may be something else adding issues. Also alcohol can muddy LFT’s in some, especially if drinking alcohol on MTX day or the night before your blood test. So potentially could be a few reasons. The liver is the organ which has the ability to heal itself up to a point so hold on to that, it's not always as big a problem as you may initially think.

I hope you hear back soon then you can act on any advice given. Sorry I’m not of further help.

[Briefencounter in reply to nomoreheels]

My LFTs can go up and down and I've been on MTX well over 20 years . A recent rise was , I think , due to paracetemol ( full dose at acceptable intervals ) when I hurt my hip in a fall .No broken bones but "deep tissue injury" which takes ages to heal . I was on the full dose for several months . No other change in drugs . I had a liver scan , fine , and the levels have come down , but not completely. The liver has to work very hard for us with RA , and sometimes complains .

[Pharaoh2405]

Hi Rue04,

I was on MTX for years and continually had liver issues. I ended up in hospital many times so unwell.

Ended up stopping MTX after 3 years, couldn't take it anymore. Went for 8 years, only prednisone.

Recently started on Cosentyx (biologic) I'm a new person.

[Hercane]

I too was on MTX for years. And my enzymes test were like a rollercoaster! Was able to stop MTX once I had been on Remicade for a few years, and my enzymes were kept in check.