Since the last post ive had one test come back at 73 and then the latest back up to 170.
Ive not drank in months, i dont take a single pain killer, i take prednisolone, hydroxychloroquine, sertraline and an iron supplement from the doctors.
Should i just put my foot down now and ask for another medication? Can i take anything else with a crap liver?
Do i need to see a liver person? What if my livers not good 😭
Ive been in pain since January, diagnosed since June and im fed up, just feeling like im never gonna get on meds and get sorted. Hydroxychloroquine isnt doing much, been over 3 months and im still in agony, prednisolone is taking the edge off but im aware its not a long term thing.
What do i do 😬
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Nelliekel
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This is something to talk over with your rheumatology team. It's quite common to get problems with raised liver enzymes (and often doesn't matter much if they go up and down!) but have a look at the treatment pages on the NRAS website for information so that you're well informed before speaking to the rheumy team.
With the caveat that I’m not medically qualified. Couple of things: the first is that your liver is not crap. Yes, your ALT is elevated, but it’s only just over the point where the medics start to get interested, and I may have said in reply to your last post that threshold is 150 for ALT, so in medical terms, 170 is still considered a mild elevation. Liver diseases and serious damage routinely see ALT running up into the thousands. That’s not to say it doesn’t need sorting, and I do get the frustration, completely, as was in a similar situation last year, but would just point out that both sertraline and pred are known to be associated with enzyme elevations. Pred is known to cause issues to the extent that when my ALT refused to come down, I wasn’t even allowed any to keep me functioning: for 6 months all my DMARDs were stopped, no NSAIDs, and no pred allowed. I was absolutely wrecked. My issue turned out to be leflunomide for my arthritis in combination with another med for something else, so once we worked that out and stopped the other drug that was causing issues, I was able to go back onto lef with close monitoring. Asking rheum to refer you to hepatology may not be a bad idea, and they may suggest it anyway, but have they run the bloods for autoimmune liver diseases, and have they requested a liver ultrasound? Both of those would be sensible next steps to assess the situation, even if they do refer you to hep in the meantime, but it could well be that your other meds in combination are the root of the problem, and that should also be explored.
In the longer term, if your liver remains irritated and enzyme levels deranged, there are quite a few arthritis meds you can take, but not generally conventional DMARDs like mtx. My understanding is that patients with known, pre-existing liver issues usually skip the standard treatment pathway of needing to fail at least two DMARDs to instead get put straight on biologics. Many if not all of the biologics are much more liver friendly. Because my liver levels were out of whack for months, where I would normally have needed to fail another DMARD combo under the standard pathway before being eligible for biologics, my liver issues meant I could move on to an anti-tnf early, so to speak.
Sort of unrelated, but given how much pain you’re in, I’m curious as to what dose of pred you’re taking? It’s not a magic cure-all, but my understanding and personal experience is that it should generally do more in terms of pain relief for RD than only take the edge off. Unless you’re only taking a small dose, if you’re taking pred daily and still in agony, that seems slightly odd.
Yes ive been reffered for a liver ultrasound. I am on 12.5mg on prednisolone daily. It take the pain away everything exept for my wrists and hands unfortunately.
I agree completely with what Charlie says. Specialists tend not to worry too much until it goes 3 x over the upper end of the range, which is 50. So 170 is only just triggering the policy of holding off meds. People with serious liver issues have ALT that can go above 1000.
I used to take Azathioprine, was on it for several years. However when they increased from 150mg to 200mg my ALT shot up. I had to stop and have repeat bloods and a liver ultrasound, which thankfully showed no issues, and they agreed it was the medication causing it. I was switched to methotrexate and have had no issues since. It may also be worth looking at what other meds your taking that could be contributing to the raised levels. I suspect they would want to do a liver ultrasound prior to referring you to a Liver specialist. It may be your GP would be happy organising an ultrasound, it was the GP who ordered mine and had it done at the practice fairly promptly. It may be the rheumatologist is happy to switch you to biologics, in view of being restricted with nsaids and dmards. Like Charlie says it does seem strange that you are not getting more relief from prednisolone, is it possible your pains are more mechanical rather than inflammatory? A good way of knowing is inflammatory pain is worse at rest and better with movement, whereas mechanical pain is better at rest and worse with movement. Hopefully you get some answers soon 🤗
Thank you, yes its definitely RA pain as its gone by the evenings and then comes back with a vengeance the next morning 🙈
Serendipitous post. My ALT is higher than ‘normal’ at the moment. Reading up I found that this can be as a result of muscle damage. I had my flu and covid jabs (intramuscular) a few days before my bloods. Am being retested in a month.
This may be relevant to some reading this thread. I am presuming my next bloods will be fine. 🤞
Not what you want to hear, but it took two years for my meds to be ‘right’. And they have been amended a few of times since then.
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