Just looked over my labs from 2008 to the present. My ALT has gone from 14 to 25 over that time period. No higher.

Just a quick check online showed this: Very high levels of ALT (more than 10 times normal) are usually due to acute hepatitis, sometimes due to a viral infection. In acute hepatitis, ALT levels usually stay high for about 1-2 months but can take as long as 3-6 months to return to normal. Levels of ALT may also be markedly elevated (sometimes over 100 times normal) as a result of exposure to drugs or other substances that are toxic to the liver as well as in conditions that cause decreased blood flow (ischemia) to the liver.

Also, I feel compelled to add this... I was on Methotrexate just long enough for it to throw my kidneys into failure. I was with a kidney doctor for three years following that. I will never, ever, ever take Methotrexate again.

Thanks Trooper for your honest reply.
I'm under the care of a nephrologist now because I've had kidney troubles and they're leaking a bit of blood. Every urine sample shows it, but he hasn't been too concerned and after visits every 6 months with him he just told me in December that I don't need to go back for a year.
What were your symptoms of kidney trouble? I've been having mid back pain, unexplained weight gain (not a lot but noticeable and not like me), changes in bathroom routine and my period, and worse than normal fatigue.
I'm generally quite scared right now with feelings that something is going on.

What did your doc say to decreasing your methotrexate? It does seem like this is at least in order with follow-up levels in a few weeks or at the least follow-up labs in a few weeks. My liver enzymes elevated after about the same amount of time and my doc had me decrease with follow-up labs and since still elevated decrease again a d than stop and switched to different medication. Unfortunately that dmard also has liver side effects and had to stop that a few weeks after starting. To get new labs in a couple of more weeks thinking positive for decreased liver enzymes.

This sounds pretty common from what I have heard of rheumys doing. Lowering the dose or stopping it completely until the numbers retreat. My Alt just recently came in at 73. I am now off the mtx for 4 weeks until more bloodwork is completed and go from there. 3 months seems like a long time in between bloodwork with your numbers elevated. Hope this has helped some and wishing you the best. Hate to hear this since the mtx sounds like it's working for you.

Trooper45yrs_ how long on the mtx and was you being monitored correctly. Kidney failure sound scary.

All she said about the MTX was that we'd see if that helped, but didn't ask me to increase the frequency of my labs. I'm hoping my family doc will give me a new req for blood work. I can't wait till June to see if there are still issues. My hubby suggested maybe it took that long to see improvement with the new and lower dosage of MTX?

Well, here's my take and I'm dealing with 2nd time around of elevated liver enzymes.

1. I would decrease to 1/2 dose. Not just "a little less".
Do that for 3 weeks to a month then go for blood work. I would NOT wait 3 months. Why? because MY enzymes kept going higher after decreasing to 1/2. It was my metabolism, so the reaction was delayed.

2. If your enzymes are higher at 1/2 dose, you can't stay on it. It's not safe.

3. If your enzymes just go to 100 well, not bad. You quit for awhile and retry once more to be sure it's a no go for you unless you definitely don't want to take it. If your enzymes are 500+ like mine were - you stop it and you caught it WAY before they went 3months that way!

My doctor is way over the top on these things and I think somewhere between your doc and my doc is the right spot. My doc had me reduce to 1/2 for 2 weeks. Didn't work, so he said stop. Two weeks more, they were higher - he sent me to a liver doctor immediately. Enzymes kept going so I had a biopsy - which said all was fine (minus a bit of fatty liver apparently). But, it was scary. Don't get scared, just deal with this smarlty.

Indycarr, to answer your question, the only sign of kidney issues I ever noticed (after a short time on Methotrexate) was very, very foamy pee. When I called my doc about that, she immediately had me come in for blood and urine tests, and then she had me do the test where you collect your urine for 24 hours in one carton. For the next few years, I had elevated creatinene, with blood, and protein in my urine, but I could not see it. My creatinine was up to 2+ something at its worst. As a reference, (I pulled this off of Wiki): The typical human reference ranges for serum creatinine are 0.5 to 1.0 mg/dl (about 45-90 mol/l) for women and 0.7 to 1.2 mg/dl (60-110 mol/l) for men. The significance of a single creatinine value must be interpreted in light of the patient's muscle mass. A patient with a greater muscle mass will have a higher creatinine level. While a baseline serum creatinine of 2.0 mg/dl (150 mol/l) may indicate normal kidney function in a male body builder, a serum creatinine of 1.2 mg/dl (110 mol/l) can indicate significant renal disease in an elderly female.

Also, I eventually had a kidney biopsy, which found "damage" but no active disease.

A little mathematical note here: Buddhacat mentions ALT levels 10 and 100 times above normal, and bcatz, at 500, was 11x the top of the range (assuming her lab's range is the same as yours). At 65, you are only one and one-half times the top of the range. Well worth watching, but not panic time yet.

Very good point Alto.
My mother, who is 70 has fatty liver and elevated enzymes. They were 80 AST and 97 ALT...and while high, doctors weren't too worried, just asked her to back off all the junk she was eating.

And doctors do tend to know about what will happen with most of the medication they prescribe.

Thank you everyone. I'll sit back and wait and see what comes next. Hopefully just a blip and things will go back to normal next time.