I dont understand whats happening really, my liver function test came back with alanine transaminase at 84 2 weeks ago.
I was advised to stop taking painkillers for 2 weeks and retest.
Today the result came back at 344!!
What could be causing this? I feel like ill never get started on methotrexate and that ive got some sort of damaged liver as well now 😭
With the caveat that I’m not medically qualified. Although referred to as liver function tests, ALT and AST aren’t actually liver specific, which means that they can indicate a variety of things going on other than just liver issues. They can also be effected by lots of things ranging from medication, food and drink (not just alcohol, but that’s a frequent culprit), to viruses, and other medical conditions. I’d always had normal enzyme levels until a leflunomide increase last year where they suddenly jumped. Told to stop the lef and retest in a fortnight, which I did, only for the levels to continue upwards and then stay there. Ended up being taken off almost all the medication I routinely take for a bunch of different health probs in case it was one of those, and referred to hepatology.
In my case, we think the culprit was lef in combination with another med I was taking. After stopping both, the levels did eventually and very gradually come down, and have mostly been ok since. I was seen by hep and had scans, and was told my liver was pretty good, so they were happy and rheum were able to start me back onto meds. In your shoes, I would be looking at what other medication - if any - you currently take, whether or not you’ve been drinking recently (particularly in proximity to the last blood test), and wait to see what rheum advise for the next steps. Although it may seem quite high to us, in terms of clinical elevations, my understanding is your levels would still be considered mild: in people with liver problems, it’s not uncommon to see levels routinely running into the thousands.
All that said, I understand your frustration and despair. I ended up off all meds for nearly 6 months when my ALT became deranged, and it was a very long 6 months at that. Hopefully yours will start coming back down and you can get sorted out more quickly than I did.
Thank you, this is really reassuring to read. Ive been asked to retest in a fortnight so shall do so.
Hopefully its just a blip & i can get sorted quickly.
My ALT has been raised for the last six months, though not into three figures. I pleaded with the consultant to let me reduce methotrexate from 10 mg to 7.5 and she agreed. Just had my second blood test result within normal limits so I've moved to 3-monthly tests. I have been careful with alcohol for a long time now, only drinking a little more than half NHS recommended limit, so I am pretty sure it was the MTX. Like Charlie_G, I am not medically qualified but I believe there can be multiple reasons for raised ALT. They sent me for a liver ultrasound, which showed nothing sinister. You say you've not yet started MTX but do not mention other medication apart from painkillers. Non-steriodal anti-inflammatories are known to affect the liver.
sorry to hear your liver enzymes are not what they should be.Have you access to a rheumatology nurse or the person who prescribed Methotrexate. It is a tough drug but very effective when it works. Everyone seems to react differently as well. Hope you will be ok
They have to be so careful as methotrexate can cause liver damage. I took methotrexate tablets for ages and my liver was fine. They put me onto the injections and the liver readings started creeping up, it hit over 400 and they stopped everything. Everything I’ve tried since has been useless. If you do get on it and it works for you you’ll see a big difference. Good luck
Hi, I'm experiencing increased liver function tests also. I've been on methotrexate 7.5 mg (3 tabs) weekly now for about 3 years. I'm on hold with the methotrexate now since August 18 per my primary DO and Rheumatologist. Both do not think it's coming from the methotrexate.
I'm due to have repeat blood work next week via my primary. If the liver values are ok then I go back on methotrexate.
Note: I had an episode of heart palpitations on August 18 and was monitored in the ER for twenty four hours and that is how I found out about the liver profile results. I've haven't had problems until then. I believe it was due to this episode that my liver reacted in a negative way. My rheumatologist also believes this. My anxiety level was off the chart.
When I repeat the labs, I'll see. Since I left the hospital l've been much better. I'm also putting better focus on my diet. I will touch base with you after the blood work.
Note: It's important to have your Primary and Rheumatologist to work together. I'm blessed to have that. I hope this helps somewhat.
Hope your feeling better and focus on meditating 😊
l am okay with MTX but that doesn’t mean it suits everyone
l have been taking MTX for the past 18 years. Now I am on 15mg. I am aware of its bad side effects such as liver function.They wanted to increase the dose to 25mg. I am really concerned about this and told my Rheumatologist. I had one ultrasound aided steroid injection.They took further tests . Depending on results my meds will be reviewed. Although I am reluctant but what can be done. I am sorry to hear about the issues with your liver function Neliekel. Hope things resolve for you soon
Sorry to hear of your liver issues Nellie. Realise you haven't started methotrexate yet (MTX) but just wanted to say I was on it for 13 years and it did a pretty good job for my RA, but I did have episodes where liver results would elevate & I'd have to stop it for a bit. I also had intermittent nausea, for the first few years it was mostly the day after taking it, but in the last few years it felt chronic and was unpleasant, changing from pills to injections didn't help as the body must have been poisoned after all those years on it. But - looking back it did a good job controlling the RA. I wasn't left with permanent liver damage from it thankfully. (I then went onto Leflunamide and that was excellent with no side effects for me, but for some reason it just stopped working after about 6 years on it (I'm now on a Jak-inhibitor which is working well now, after biologic Adalimumab didn't work). Good Luck and hope things improve for you 
Hi, I take methotrexate and Hyrimoz. In my case, if I drink alcohol my liver enzyme readings jump. It doesn't take long for them to recover once I stop. Christmas, a wedding, a holiday - where I drank more than I would usually (tend not to drink very much at all normally) followed by a blood test showed inflated enzyme levels. I'm not teetotal but was advised if I took methotrexate to keep alcohol to a minimum.
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