Alkaline phosphatase

[Northerner1]

Hey all,

Thanks for taking the time to read my post,

Background: I was diagnosed with RA in Oct 24, and have been on 15mg methotrexate and 20mg hydroxychloroquine (with 5mg of folic acid six days a week). I also take statins for high cholesterol.

I’ve been having fortnightly then monthly blood checks, however my latest bloods have shown elevated alkaline phosphatase levels, with the doctors requesting additional checks.

I know the right thing to do is wait for the doctors (I’ve appointment with the nursing team in a few weeks, and then the consultant next month), however I wondering whether the methotrexate would have cause this, if it is linked to my RA, or something else will have caused it?

Has anyone else had experience of elevated levels?

[welsh12]

It's early days on the meds do you mean 200mg hydroxy? My levels in a few areas are sometimes elevated and the rheumatology clinic checks them and will follow up which they are doing in your case they would tell you to stop if they were concerned.

[Northerner1 in reply to welsh12]

Thank you for the reassurance - and yes I meant 200mg.

[Runrig01]

So alkaline phosphate is one of the liver enzymes. It can often be raised, and often not an issue, unless it’s more than double the upper limit. If that’s the case they usually recheck in 2-4 weeks. If higher than double they would usually reduce your dose then repeat in 2 weeks. Often it settles on its own, I wouldn’t get too stressed about it. I had raised levels with azathioprine, where I had to stop and have an ultrasound of mg liver. By the time the ultrasound was done, 3-4 weeks later, my levels were back to normal and scan was fine. I was then switched to MTX, as I needed the high dose of AZA, but it was affecting my liver. I’ve been on MTX 8yrs with no issue.

The whole idea if these blood tests is to pick things up quickly, and adjust treatment if needed. As I say they often settle on their own, and only really a concern when more than double the upper limit

[Northerner1 in reply to Runrig01]

Thank you for this, very helpful. First time something has been flagged so was a little concerned.

[Ali_H]

it could simply be a vitamin D deficiency 🤞🏼 a simple blood test will answer that one and supplements fix it!

Or RA related as raised levels are common in RA patients

All the best

Ali

[Northerner1 in reply to Ali_H]

Thanks 🤞

[Jacey15]

Alkaline phosphatase comes in four different isoforms. The most common two are from your liver and bone. They usually do other tests to determine which it is, for example, ALT and GGT, a liver specific enzyme, and calcium, phosphate vitamin D and Parathyroid hormone to see if it's come from your bone.

[Northerner1 in reply to Jacey15]

Thank you. Will see what happens after the next set of bloods