what were your liver numbers before, your baseline, before taking mtx? do you have any undiagosed or diagosed co morbidities (fatty liver, obesity, any other diagnosis any other meds that filter through your liver that you get tested for now and then)?

your primary care might have taken a baseline of your alt/ast numbers before you started on the mtx, if so can you sign onto your patient portal where the med results might be and look at your numbers before 10 weeks of mtx?

Ask your rheumatologist also on her / his patient portal if you have concerns about your numbers as pertains to your taking of mtx

are you drinking ANY alcohol? if 100 folks answer on here, you are going to get 100 different answers between how I can love my craft beer and my mtx to I do exactly what the rheumatologist advises. i think most doctors might answer that there is a difference between one beer a month at the wedding and weekly / daily ingestion. again, ask your rheumatologist. my rheumatologist asked me for my exact actual ingestion of alcohol / habits / before starting me so long ago on mtx. If someone rather have their wine or beer daily - a doc (not me) is going to say this probably is not the med for him/her (guessing) :)

we are all different on here so you are going to get a range of answers - when I take levaquin for my frequent pnneumonia's my liver numbers elevate. but then they go down. example only, no medical advice. :)

what is your dose of mtx- is it the highest or did she start you low and titrate you up?

the rheumatologists all have a specific plan of action for how frequent they want to test on MTX. my rheumatologist does standing orders for 90 days and we discuss every 90 days unless I am testing out of wack. then she titrates the meds or have a temp cessation and we re-test in 30. Your doc will have her action plan.

liver is very sensitive to BMI (body mass) also my doctor intones.

depot

Depot gave you lots of good info.

What dose of MTX were you started on? What dose do you take today?

When I started MTX I had blood work every week for the first month or so, then every couple weeks, then monthly...... Since I've been in drug controlled remission, I have bloodwork every 3-5 months now.

I'm one of those who never had abnormal liver function test results....except for two instances:

1. gallstones [surgery made the LFT's normalize]
2 when I drank Nyquil round the clock for a terrible pollen allergy.

My first blood test's only irregularity was RA. Liver #s normal. Re-tested after 30 days on MTX with no notable change in numbers. My doc did ask what I drink and I told him wine, daily. When I last saw him the end of October, he wrote a script for next blood test in 90 days. I am on 8 pills/week.

My doc was also released from the practice the day I saw him, so I don't even HAVE a doc, I guess until January.

If I were you, I'd make sure you HAVE a rheumatologist - and a GOOD one. You need to know who it is. If you have the kind of insurance where you can just find your own, do it now. It can take months to get in with a good doctor.

Might be a good thing the doctor was released from the practice. Anyone starting out on MTX should be getting frequent blood tests in the beginning, ESPECIALLY on that dosage.

Also, you should NOT be drinking when you are on MTX. Why not? Because MTX by itself can alter liver function. If you drink as well, then the liver is further compromised and the LFT values may be further elevated.

I second the no liquor. I have known an number of women, who only had one drink at Christmas. And the next blood test, the enzymes shot way up. I never drink, because I have had such bad issues with mthx related high enzymes, so I figure, why play with fire? Probably some people can get away with it, but what if you are not able to? JMO

I was on mthx for 9 years and it worked well with a biologic. The early years, my numbers were about 75 for ALT. That was 50% too high, but my rheumatologist let it go. Then they started to climb. Another doc gave me the last year's CPS, and told me to go through everything I was taking, and see what was affecting me. I had been on Reactine for probably 10 years, never tested for liver as a baseline or retests. It was the only thing besides mthx listed to raise liver enzymes. So I went off, and within a month, the enzymes were back in the range of normal.

As that point though, I was quite heavy. That was when I got on Kineret/mthx, and off prednisone totally and started losing weight and exercising. In one year I lost 80 lbs, and my liver went from fatty to normal. Such a change that the radiologist thought the year before's liver was the wrong one. Nope! That's what happens, I guess when you lose weight.

But, ironically, when I lost weight, is when the liver enzymes started to go crazy high, in the 1000s at one point. I started getting huge mouth sores, which my family doc though was mouth cancer, the sores were so bad (painful, too). Short story, 2009 was the end of 9 happy years on mthx. Mouth sores disappeared immediately. Liver enzymes back to normal except on Actemra, which didn't last long.

So Simponi failed Feb. 2015. After trying a number of things, including Xeljanz, I was finally getting some control with Arava/Orencia. But nothing like I had in the good years. I felt it was the Orencia that wasn't working, but my rheumatologist, after some persistence with the liver specialists, finally oked me to start the mthx, 7 years later. And my body remembered! One day nausea the first shot, about 2 hours the second week, and none after that. And at two weeks, things started getting better.

So, I'm supposed to be losing 50 lbs for the liver specialist. But strangely, my liver scan came back normal. Not that I don't want to lose weight! But I have more than cut the prednisone in half, and the stomach is melting and the pounds are coming off, and I am not doing much - well except exercising!

So I read somewhere, that it is very important to use fats with mthx. I have no idea if it was in a forum, just a random idea, or on a medical forum. Or maybe I imagined it? Last 80 lbs loss, I cut fat out of the diet completely. This time, I'm making sure I get fat at each meal, including good fats, but also butter, coconut fat, olive oil, Omegas, although not corn or canola. And my test this week - normal. So 11 weeks into the program and I am doing fine.

If I should ever get into see the liver specialist again, I am going to see what she knows about mthx and needing fat. Not too much fat, of course - but a normal amount. I'm hoping things will stay well.

I'm getting my winter itchies again. I have no idea why - but Benadryl helps. I hadn't taken it in months, and I won't again, but the itching is gone today. Benadryl is a really bad one for raising the enzymes, any anti-histamines, as Lynn says above. So OTC is important too. Don't use a lot of OTC's that raise the enzymes, and then blame it on mthx.

As for the OP, and not getting testing till January, I am a little bit shocked. Canada does not test a lot, and I was every week for the first month, and now monthly, as I always was. I keep track of it - print up a copy, and make sure things aren't going south. I would see your family doc and get liver tested, as soon as possible. I would also drop the daily wine, sorry to say, although you seem to be tolerating, from your first test. But why push it, when you don't have to? JMO

I forgot. I have met one woman who was on mthx for 28 years. She was also on Rituxan, but never had her enzymes moved above normal in that whole time.

So, some people have all the luck! You don't necessarily get liver damage from mthx. In fact, when my liver enzymes went down, there was no damage at all in the biopsies. So even high enzymes doesn't mean liver damage. And the liver does repair itself, if you go off. Maybe that also happened to me??

Marlene -

When you get out of the bath or shower, dry off and then immediately slather Cetaphil [or Jergens or other popular brand] all over your body. The idea is that the pores are open after bathing, and this allows better absorption of the lotion. The pore close and "lock in" the lotion. Use the regular cheap stuff. Paying a ton of money for supposedly great products has absolutely no merit.

I don't know about fat and MTX.....all I know is that I always take a hi carb meal before taking my weekly MTX. Back in the days when I was taken 25mg weekly, this really helped calm the nausea. Never knew why, but other patients reported the same thing. All I know is that it was "permission" to indulge in pizza.

Can't find anything to say that fat needs to be used with MTX. Found this

https://www.ncbi.nlm.nih.gov/pubmed/1622413

which says that diet has no impact on MTX bioavailability or absorption.

Maybe it was mentioned in relation to diet/weight?
There's lots of evidence that healthy body weight puts less pressure on joints and reduces risk of fatty liver. It's also the case that MTX dose is based on body weight so to some extent I'd guess that if I lost weight I might find that a lower dose of MTX was the therapeutic treatment? That would hopefully be less toxic to my liver.

How best then to lose weight with RA limiting exercise. Diet I suspect!
It's confusing though. Fats are said to be pro inflammatory. However,
there's lots of evidence emerging that the advice re low fat diets for weight loss in the last 50 or so years was misguided and that loss of visceral fat in particular is more likely by maintaining intake of good fats, avoiding the corn oil etc and reducing sugar /carb intake instead of good fats.
Maybe that's where the fats/ra/MTX link is?
Fats or low fats...I dunno.
Just know it's fatty foods like Mac cheese I crave to settle my MTX nausea!

Sorry Suzie....to get back to your original question, my baseline and ongoing liver enzymes have all been within normal limits since I started MTX in July. Bloods have been fortnightly throughout because it was new treatment, then because my wbc raised a little (?unknown infection) then because my dose increased, otherwise would be monthly bloods by now.

I thought I was the only one that eats to settle the almost constant mtx nausea! Anyway, my ALAT/ASAP (I think these are the liver numbers, right) were only 16. My concern arose when I saw blood in vomit yesterday. Not a lot, but concerning.

it feels normal for mysel to need somethig when I have nauseau with my mtx. after all these years the nauseau feels like being pregnant

you are testing at a liver number of 16 with daily wine? mama mia. i would not ruminate on this as an issue unless a doc tells you to ruminate. maybe you were just vomiting so much you irritated the lining. can you call the office of the new doc before your appointment next month if it is concerning to you?

depot

When you vomited, did it look like coffee grounds?

Are you taking NSAIDS?

Suzie, do you regularly vomit on MTX or was this a first?
Do you have any other signs / symptoms which are worrying you in relation to liver toxicity?

If you're also taking NSAIDS, like most of us with RA do, some of them may cause bleeding ulcers [e.g., Naproxen, Advil]. Celebrex is the least likely to cause the ulcers.

I've never heard of anyone vomiting from MTX.

It did look like coffee grounds and I'm not taking any NSAIDS. It was the first time and weird. Severe quick onset headache caused the nausea. I'm hoping completely unrelated to my mtx taken wed (this happenew Thurs morn).