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Rheumatoid arthritis is a chronic, inflammatory, multisystem, autoimmune disorder. It is a disabling and painful condition which can lead to substantial loss of mobility due to pain and joint destruction. The disease is also systemic in that it often also affects many extra-articular tissues throughout the body including the skin, blood vessels, heart, lungs, and...

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Elevated ALT/AST

oceans11
oceans11

So I just got back from my normal scheduled RA visits & reviewed my labs with my Rheumy. I am a little worried because although all other area's were normal my ALT & AST came back elevated AST 139, ALT 101!! I have had elevated liver enzymes before especially while on MTX but I haven't been on ANY RA Med's since 12/2015. 


When I had them before they always went back down to normal but I had to cut my usual weekend beers. I wonder if my body is just very sensative to alcohol. It's not like I'm pounding like a college student. I have 3 beers on Friday after work & maybe 3-4 on Saturday. I don't drink from Sunday thru THursday & my lab was done on a Thursday so far enough away (I think) from my last drink to not even show up, (I think). 


I also lift weight during the week & I did read some interesting tid bits on how lifting heavy weights DOES elevate liver enzymes & I had just worked out the day before. 


I don't know, I'm going to try & NOT stress out since I've been through this before but this is the highest it's ever been & when I google results for other people they're freaking out over being at barely 50/60! 



Anyone else have any experiences with elevated enzymes NOT due to the medications & still being okay?


depotblue
depotblue
what did the rheumie say? what does your primary care say? do you want to see a liver specialist - if so can you ask for a referral? have you ever considered asking the primary care to write a referral for a registered dietitian (RD) who can discuss special lifestyle changes just for your liver? have you liver even had an ultrasound done of your liver or an mri? do you know what fatty liver is? what else is filtering through your liver medication regime wise? nsaids? these are some questions for your medical care team.

sorry you have to work on this. bummer.

depot
oceans11
oceans11
Hi depotblue,

My rheumy stated he wasn't worried about it because I've gone through this before although not as high on the enzymes. I believe from what I remember I had been up to 98/85 before & it came down to normal levels. The only portion that concerns him is that I'm not on any RA meds at all that would effect the levels & he won't know what the issue could lean towards until we do another set of labs, due to the fact that I had been drinking on vacation in Vegas 2 weeks before & then came back for 4th of July & of course I partied a bit that whole weekend as well. Oh also, in between all that I had back issues so I was taking Aleve & Advil intermittently. So he wants all that out of my system first & see if the levels drop off.
altoclef
altoclef
You may have just answered your own question. NSAIDs, combined with a "lost weekend" in Vegas followed by the three-day July weekend may have tipped you over the edge. Hope it goes away.
oceans11
oceans11
@altoclef,

Yeah, you're most likely right.
MarleneJ
MarleneJ
I didn't get off mthx till my enzymes were over 300, so I wouldn't worry yet, esp. since your rheumatologist is not. Be careful of Tylenol and antihistamines, as they affect the liver. And many psych meds do. My enzymes were actually high (75 for ALT) before I started any RA meds. But they stayed in the same range for quite a few years. Then, I got a copy of the Canadian CPS, a book that the doctor's and pharmacists use to prescribe, look for side effects, conflicts. I looked up every med I was on. Reactine, an antihistamine I was prescribed for asthma had the worst side effect listed as "raised liver enzymes." I went off of it, and my enzymes became normal for quite a few years.

"So, don't drink, don't smoke and don't go with girls who do!" Just joking - always thought that was a funny saying! But seriously, don't drink, I have known people who literally NEVER have elevated enzymes and they have a drink or two at Christmas, or wine on a cruise, and bang! The enzymes go up!

So many pit falls and things we have to be careful about. I hope your enzymes come down.
oceans11
oceans11
@ Marlene
Thanks for the info Marlene it's appreciated always! Yeah it's always kind of "freaky" when the doc FIRST tells you about it & then starts asking all the "what, where, why, when" but once we went over what I was doing then he wasn't too worried so I won't be either. Not unless the next labs show it still increasing or not coming down at all. I had no idea also that the enzymes seem to take some time to come down. It's not like if you drink one day or take a med one day & stop one day then on the 2nd or 3rd day you should be down to normal levels. Liver scaring or damage is just like any other damage, once you stop the damaging effects it takes a little while to fully heal.
depotblue
depotblue
don't listen to us :) - talk to the person with that diploma thing on the wall. fatty liver is pretty crappy for some folks the enzymes just elevate and elevate - and an ultrasound will show you a beautiful picture of that liver - instead of just lab numbers. you'll get your answers but the rheumie at this point can not supply them all - the primary or liver doctor can. i would not doctor google. i would in person talk to the primary or liver doc.

depot
oceans11
oceans11
@depotblue,
I hear ya db, but at this stage I'm going to wait for the next labs. If they stay status quo from the previous labs then we'll definitely refer myself over to the liver specialist. If it goes down steeply like it did the last time then I he'll make the decision at that time. But the key right now is get a "true" baseline for my enzymes. In my opinion my last results were most likely clouded by all the drinking I did & the Aleve I took for my back & simple aches & pains. But we shall definitely see come 2 weeks from now.
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