Raised Alt moving to methotrexate


I started Sulfasalazine beginning of may . By the end of week 4 I was reacting badly swollen mouth , lips, rash ulcers . I was on holiday and was advised to go to a&e I was given pred . Got the call from rheumatologist nurse to stop alt was 131 .

Bloods done a week later level went to 196 . Saw rheumatologist on Tuesday Told to do more bloods . Got a call on Thursday Alt level 1556, and need to go to hospital . Had liver scan which was clear and they let me out last night , level down to 1200, going back as an outpatient on Monday for more blood tests.

When I was at my appointment on Tuesday rheumatologist said about going onto methotrexate in a month .

I’ve got a call in 4 weeks time with the nurse to get my prescription. Feel like this is moving too fast, I feel like hell. I know my bloods have to be normal before I start. Spoke to pharmacist whilst I was in and they said have to go through each drug until they find one that suits.

Do the side effects with methotrexate outweigh the benefits? I’ve got this message in my head saying I’m crazy thinking about taking it . If I get another spike in raised Alt will this damage my liver? . I’ve been told to keep off paracetamol and alcohol.

can methotrexate cause problems with the liver?


  • chrisb
    chrisb Moderator Posts: 680

    Hi @Sweets  

    Welcome to the Versus Arthritis forum. 

    It sounds like you’ve had a tough time with Sulfasalazine giving you some nasty side effects. 

    You have now been prescribed Methotrexate and would like some input from forum members as regards potential side effects and implications for the liver. Well there are plenty of forum members who have experienced Methotrexate so you’ve come to the right place for some feedback. 

    In addition to members’ comments you may find the following links useful:

    I hope that the above articles plus input from community members are useful in helping answer some of your concerns and that if you do experience side effects that they are minimal. 

    Best Wishes

    ChrisB (Moderator)

    Need more help - call our Helpline on 0800 5200 520 Monday to Friday 9am to 6pm

  • stickywicket
    stickywicket Member Posts: 27,712

    As a fellow autoimmuner I feel for you. That must have been, and probably still is, very scary. A friend was called back from her holiday some years ago because the blood test she'd had before leaving showed that her biologic was also raising her ALT levels to dangerous heights. She felt fine at the time. Now, she's on a different biologic and methotrexate and has been on them for years.

    The problem for us is that all these DMARDS have the potential to produce bad side-effects. Mostly they don't and, even if they do, as long as we are conscientious about our blood tests, all should be well though it might mean trying more than one before we find the right one, or ones, for us. I've been on methotrexate and hydroxychloroquine for over 20 years. I always check my ALT levels. I'm blessed with a very tolerant liver but I still only drink alcohol well within the recommended limits and nowhere near as much as I'd like to. And never on my methotrexate day.

    The trouble is everything is processed in the liver. It's a real workhorse so whatever we take goes through it. But........

    If you're thinking of not taking any more scary meds, think again. Please. Side effects are only potential. The actual effects of an inflammatory arthritis, if untreated, are every bit as devastating if not more so. Not just joints but internal organs too.

    Your experience has been horrible but your medical team, and you by going for the blood tests, have done the right things. I'm confident they won't put you on methotrexate until they see it as safe. Oddly, people are sometimes put back on a DMARD which has caused liver problems, after it's settled, and had no further difficulties.

    I hope thing swill be smoother for you from now on but do raise any concerns with your medical team.

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  • SausageFingers
    SausageFingers Member Posts: 34
    edited 21. Jun 2021, 15:31

    Good grief, they're high readings (1556).

    They won't let me go on MTX if mine are above 60, and I haven't pushed it. I'm not that desperate as I am not suffering too much with pain etc.

    I had a blood test a couple of weeks ago and my ALT was 105. But nothing to do with MTX, that was basically just 150+ units of alc per week for god knows how long haha (a year or so at least). Yes I know, that's a problem...

  • Sweets
    Sweets Member Posts: 5

    Thanks for all of your replies , blood test again today , now down to 1040 fingers crossed back to normal in a couple of weeks .

    The care I have had at hospital is outstanding, had a call from the rheumatologist consultant today went through what had happened and we talked about methotrexate feel really relieved now .

    thank you once again

  • Kitty
    Kitty Member Posts: 3,583

    Hi, as an RA sufferer since 1987 (age 36 - now 70) I've been on Methotrexate for most of them, although I preferred Sulfasalazine but my Rheumy won't let me have it. I also take Leflunomide (Arava). If the Methotrexate tablets give you bad side effects, you can be taught how to self inject. I self injected for 5 years successfully, but I'm now needle phobic so it's back on the tablets for me.

    My daughter in law has Truxima infusions (biolosimilar) and does very well on them.

    All the best.

    "Women and cats will do as they please, and men and dogs should relax and get used to the idea." Robert A Heinlein