Letter from my Rheumy

Kitty

Just received letter from my rheumy. It says:

"Dear Kathleen, Your most recent blood tests shows a slightly raised enzyme of your liver. It is not alarming but needs careful monitoring. I am therefore reducing the dose of Methotrexate to 20mg once a week (rather than 25mg that you are currently taking). "

My GP will receive a letter, well actually I think she's already had it as the surgery rang yesterday to ask me to make an appointment for a blood test which I already had done anyway. Have been having monthly ones for ages now.

1. She has been telling me about my lft results being slightly elevated for ages now, before she increased it to 25ml. So this information is not new. Wondering now if this is an excuse as a friend very kindly forwarded me a warning about MTX 25ml injections from Creaky Joints.

2. When I saw her last (May 18th) and my LFTs were already being questioned, she was talking about increasing my MTX to 30ml!!

Something wrong here methinks. Any thoughts??

As5567

If I remember correctly it's very common for liver results to change whilst on Meth. Some gp's are more cautious than others and I highly doubt your consultant would prescribe the higher doses if he/she thought your liver results were abnormal.

It could just be a temporary measure being put on 20 or it could be the maximum dose you can tolerate. I know that I myself can't take more than 17.5 or my liver results come back bad, but at 17.5 they are in the acceptable range.

Also if you wasn't aware drinking alcohol while on meth can have an impact on the liver blood results, I know that some people aren't made aware of this.

The main thing is that you're having regular bloods and these things get picked up by those blood tests well in advance before any damage can be done.

trepolpen

hi kathleen

ALT will be your liver enzyme , it shows inflammation in your liver & one reason they do monthly blood test

I had this with Methotrexate & had to stop the drug for couple of years & when started it again , same thing happened , but this time they increased my folic acid to 6 days a week taking 5mg , after this my ATL has returned to normal & has been for last 8 years

What level of folic acid they got you on now & maybe ask to increase it if it continues

Kitty

I do understand the reason for the reduction due to LFT results. I've been taking 25ml injections for 10 years, with a 2 year break for chemotherapy, and I don't drink - well, one sherry on christmas Day. I take a Folic Acid tablet every day except for the day I inject. I'm also on Leflunomide 10mg and have been on a reducing dose of Pred since September 2014.

I've had an elevated liver enzyme result for 6 months, even before she increased it back to 25ml and before she mentioned increasing it to 30ml. But when I heard of a possible problem with some batches of MTX injections, it made me a bit suspicious. Wish I'd never seen the ****** article now. :x

Starburst

It must be frustrating not knowing what the real reason is. I do agree that it seems strange that she was willing to raise the dose and suddenly, drop it. Occasionally, hospitals change their policies or new research/information comes to light. I think opinion comes into it too. My rheum was horrified that I didn't stop my humira prior to an arthroscopic jaw procedure but the max fax consultant said there was no need. My clinic get very antsy with raised liver enzymes but I've heard of other clinics who accept that it's par for the course on some RA drugs.

I hope you get answers.