Elevated Liver Enzymes on Methotrexate? Don’t Panic Yet

Introduction: Methotrexate and Liver Concerns 0:00

Your doctor just told you that your liver markers are elevated. You are on methotrexid for your rheumatoid arthritis and you are worried that the metotrexit is causing liver damage. you went to the internet and start searching about metho trexit and liver damaged and are panicking. But here is the truth. up to 15% of the patients who are taking methotrexate for rheumatoid arthritis, they can have some liver marker elevation. But the truth is, very few can get liver damage with methoxite. In this video today, I'm going to tell you exactly what methodrexit does to your liver and who is at higher risk and five practical steps that you can take to minimize that risk of liver related problem with methotrexide.

Before we dive deep, a quick question. Have you ever had any liver marker elevation while you were taking methotrexate? Please put a comment yes or no in our comment below. This will help other RA warriors understand better about metotrexit. Let me start with a story of one of our patients. let's call him David. He came to me with the history of rheumatoid arthritis for the last three years. His RA was doing very well. It was on methoxid, which was controlling his rheupertoritis. One day, during his routine blood test, we found that his liver marker was elevated.

Now, as we discussed earlier, David went to the internet and he starts searching about methotrexid and liver damage.

Patient Story: Mild Liver Marker Elevation 1:24

And he's in a panic mode. Later, I saw David back in the clinic and explained to him that the liver related problem with metotrexxid is not uncommon and his marker is mildly elevated, As we dig deeper, we found that he was taking ibuprofen to manage his headache, which might have contributed to the liver marker elevation. After he off of the ibiprofene, his liver markers went down. And we even did some further testing to look at his livers with ultrasound which showed a healthy liver. This story tells us that liver market elevation is not uncommon, but those are minimal elevation and it does not cause long term damage in most of cases.

Now, let me understand more on why methadoneic acid could potentially cause liver marker problems. So think of your liver as a water filter. Everything that you eat, drink or take as medication passes through your livers. And your lever job is to process and clean everything in your body. So this is a filtering machine. Metatrixid also passes through your liver and sometimes it can create extra work in your livers causing that liver marker elevation. Now understanding this help you understand better why metatixid cause liver markers elevation and how we can prevent this.

There are two main types of liver problem that can happen with methotrexate. The first one is a short term or acute problem, and then the second one, is the chronic long term problem. Let's focus first on the acute problems. Methotrexxate can cause acute liver marker elevation in your blood test. it typically happens around 15 percent of the time.

How Methotrexate Affects the Liver 3:04

And the elevation of a liver marker could vary depending on your methotrexate dose as well as your other medical conditions. Typically, these liver markers elevation are temporary and they go back to normal after we doze, adjust the metotrexape or after. We understand the cause of that liver elevation. If you have mild elevation off your liver, marker that does not mean liver damage. Now, the second type of problem that can happen is chronic liver issues, and that includes fatty liver, fibrosis, or really cirrhosis of the liver which is a serious medical condition.

For methotrexate to cause this long-term problem, it takes many, many years, usually more than two years. It is more common with higher cumulative dose of methotrexate use. And patients who develop this long-term problem, most of them, they have other risk factors. We'll talk more. If you don't have those risk factor, your risk of developing liver related long term problem is extremely rare. So it's very important for you to understand those risk factors. And if you have those risks factor, it is better to avoid methotrexate so that you can talk with your rheumatologist.

When we look at the literature, the risk off liver-related problem, is overestimated. The study shows that about 7% of the patient could get mild fibrosis and less than 1% develop cirrhosis. That's why it's important to understand what is the risk of methotrexid causing liver problem. It's typically less that 1%. Now, let's understand who are at higher risk.

Acute vs. Chronic Liver Problems 4:46

And I have highlighted these key risk factors. Number one is alcohol use. Both the alcohol and methotrexate goes through your liver. If you are taking excessive amount of alcohol along with metotrexit, you're at very high risk of having long term liver problems. 2. Diabetes, which is itself a risk factor of liver issues, we call non-alcoholic fatty liver disease. If you have diabetes, your risk of methotrexid-related problems might be higher. 3. Pre-existing liver diseases, for example, if you had cirrhosis, hepatitis, that itself is a risk factor for cirrhosis.

So in this situation, we typically avoid methotrexate. The other is OLRase, which is another important risk-factor for Cirrhiosis. Next one is Obesity. Excessive weight also increases your risk of non-alcoholic fatty liver disease, within itself, is risk a factor of chronic liver diseases. When you take methtrexit, if you have obesity, your risks might be higher. High cholesterol and other medications used that also affect your liver are other risk factors. If your rheumatologist is prescribing methotrexate, make sure that you review your medication list with the doctor so that we understand better about your risk of having this long term liver problems.

Having this risk factor doesn't always mean that you cannot take methotrexate. If you have these risk factors and if you are applying methtetrexxate, always understand your risk. The risk of the side effect of metho trexite and the risk not treating rheumatoid arthritis. So we need to understand those two risks before we decide the right medication. But occasionally, If you have multiple risk factors, then we need to understand better and we do find the right drug for you. So in that case, have a good discussion with your rheumatologist whether methotrexate might be a Good choice for You or not.

Now, let's understand what are the things we can do to minimize your risk of liver related problem while on metho trexite. And the number one step is taking folic acid every day.

Who Is at Higher Risk 6:54

Studies have suggested that if you are taking methotrexate every day, we can minimize the risk of liver problem by 77%. Somebody who is taking folic acid, there is 61% less chance for you to stop metho trexed because of a liver related problem. So it can help you retain medication, meaning that you can continue to take methodrexit if take with folate acid. Now, the step number two to avoid liver related problem is limiting alcohol use. As we discussed earlier, alcohol also get metabolized by your liver.

So is methotrexate. If you are taking both, your livers need to work extra hard and that might cause some liver marker elevation. Minimize alcohol as much as possible. The safest way to minimize liver related problem with methotrexate is to avoid alcohol. But if you really need to drink, if your drinking socially, try to minimise the lowest dose of alcohol that you can consume. That will help protect your liver. The third important step that you can take to minimize methotrexate related liver side effect is manage your metabolic health.

That includes your diabetes control, controlling your cholesterol, managing your weight. Those are the three important tools that will help you minimize your metabolism liver disease and that also protect your liver. And the step number four is very important, and that is to watch your other medication. So always review a medication that you are taking, whether they will interact with methotrexate or not, And whether those medications can affect the liver function or Not. Whenever your doctor prescribes you any medication, always ask, is there an interaction with this new medication with your metho trexite?

And here are some of the common example of medication that can interact and could increase your liver markers. Number one is an antibiotic that you typically take for urinary tract infection called Bacterium. The number two is other non-steroidal anti-inflammatory such as ibuprofen or naproxen that could also increase the liver marker.

Five Ways to Reduce Liver Risk 8:48

You can still use those medications in consultations with your doctor but we need to watch your liver marker closely. The third medication sometimes get confused is Tylenol. You still can take Tylinol but stay under the limit, typically not exceeding more than 3 grams per day. Ask a rheumatologist on how much tallol you can take while you are taking methotrexate. A pro tip to minimize liver related issue with the medication is having your list handy with you all the time so that when you go to any doctors, ask them whether the new medication could interact with your metho trex.

And the fifth and very important step, very, important tool is to never skip your blood test. The best way to understand whether you are having any liver related problem with betatrixid is having regular blood tests. You do not have any symptoms if you have mild elevation of your liver markers. So having those regular block tests is the key in minimizing long term liver problem or long-term liver damage. While we are doing those blood tests, if you are known to have mild elevation of your liver markers, we need to adjust your methotrexate dose.

We need understand what is causing that elevation. And if we can fix that problem, then it is not going to cause long term liver problems. So this step is very important that having a regular blood test. The frequency of doing the blood test do vary depending on what dose of methotrexate you are taking and how long you have been on it. Typically, when you're first starting your metotrexxate, we typically recommend doing a blood tests two to four weeks. But if you on a stable dose, it is typically recommended to do every three months.

to monitor for those liver marker elevation. And your rheumatologist typically take your AST, the ALT. Those are the two liver markers that are typically checked to look at your liver health. Albumin and platelet count are other tests that tells us how your body is doing with methotrexac. Now, let's also learn about some of the red flag signs that you need to be very, very careful. And if you have any of those, you to let your rheumatologist and your primary doctor know immediately because these are the Red Flag sign, which could mean liver damage.

The number one is yellowing of your skin, a sign of jaundice, could indicate severe liver failure. Number two is dark urine and typically palestal, also means liver damaged. The other symptom is severe unexplained fatigue which could indicate liver damage. If you're having pain or swelling around the right side of your tummy area, which is the area where your liver is typically located, if you have pain in those areas, let your doctor know immediately if in case we do worry about liver damaged. If you are also having unusual bleeding or easy bruising, that sometimes could mean a problem in your blood cells.

If that's the case, you need to let your doctor know immediately so that we can minimize any type of liver damage. And if you have any of these symptoms, let you doctor immediately. Don't wait for your next follow-up appointment. Now all of you rheumatoid arthritis warrior hope you are learning more about methotrexate and the liver and I hope this is decreasing your panic attack

Warning Signs and When to Call Your Doctor 12:04

and let me leave you with these five important tools that you need to have while you're taking metho trexite. Number one is take your folic acid every day. Number two is limit or avoid alcohol. Number three is manage your weight and your blood sugar. And number four is take for other medication that could affect your liver. The number five is never skip your scheduled blood test so that we can understand liver related problem early. If you follow these steps, then we can minimize problems with methotrexate.

And if you remember our patient David, who was panicking while he had mild elevation of liver marker, but as we dig deeper in David case, his liver market elevation was due to his ibuprofen use. After he stopped it, is liver. Marker went back to normal and he never had any liver damage. and we can do the same thing in your case. So always be vigilant. If you like this video, please give us a thumbs up. Subscribe to our channel so that more of the RA warrior can find these type of content that will help them minimize their panic attacks.

And I'll see you in the next video. Bye bye.