mtx affecting liver | Arthritis Information

 

I just got some new blood test results and my liver values are off--one of the most treacherous side effects of methotrexate . I don't know that much about it but the value is called ALT; normal is between 5 and 40. Usually I would test out at 29 or so, but now my ALT is up to 46. I'm really upset.  I'm already losing sleep wondering what this drug (mtx) is doing to me--now this is not helping. And lack of sleep makes my PMR worse.  I got this info via letter from my rheumy. All she says is that the ALT is high and she will continue to monitor it with blood tests. As I said....I am pretty upset and don't want to take this medication anymore!  It just seems to be complicating everything.  I know if it were a dangerous level she would tell me to stop taking the drug immediately, but who decides what is dangerous? I do like having a liver. freesia22010-11-15 09:23:50Freesia, sorry to hear about the test results and can understand your concern.  It would be nerve racking not knowing at what point your rheumy would discontinue the mtx.  One good thing is the liver can repair itself.

Hi russellcat, thanks so much for  your response.  I do drink lots of fluids--water, decaf tea, decaf coffee. Maybe I should concentrate more on the water? When I'm home, which is most of the time, I'm constantly drinking liquids! I think that water does keep the liver flushed out.

How long have you been taking mtx? For me it's only been 2 and a half months.  I'm so glad for you that you have had good blood tests so far.  Did your rheumy discuss the reasoning behind taking mtx when there's no proof that it works for PMR?

That is good news that the liver can repair itself....but why even get to that point if one doesn't have to? Know what I mean? It just seems that since starting the mtx, things that were okay are going cuckoo--like my thyroid, my liver--and of course, I got the mouth sores.  I'm starting to feel like I'm being slowly poisoned. Sorry to be a wet blanket, I don't want to put a damper on this medication which may well work for you and others!! I started out feeling optimistic and hopeful.   I'm going to get in touch with my rheumy tomorrow. 

thanks again, take care--
freesia
Update: I haven't been able to talk to my rheumy yet, but my primary care doc was kind enough to talk to me about the liver values. Apparently, the ALT level is not dangerous unless it is in the hundreds, or even the thousands...then there is a real problem. So I guess I overreacted--but better safe than sorry. Besides, I still say my body is getting confused by all these medications!
freesia

Too bad your rheumy wasn't nice enough to let you know more info on what you out of spec levels really meant, it would have saved you alot of worry. 

I've been on mtx since around June.  I take 12.5mg every Sunday and so far haven't experience any side effects, knock on wood.  I just had my first visit with a new rheumy this past week it was his opinion also that mtx is the way to go with PMR.  I think you are in the US and it sounds like maybe this is what they do here.  Who knows???? Further update: I talked to my rheumy and she said to go ahead and discontinue the mtx and see how I feel.  At least it will stop the worrying about side effects. And stop the side effects !  I hope it's the right thing to do in the long run. I guess one can always resume taking it if necessary.  I have an apptmt to see her Wednesday so we can discuss things further.

russellcat: I posted this before I saw your post. Thanks so much! You're taking a bit more mtx than I was. I was taking 10 mg per week.  About the Folic Acid: definitely I was taking 1 mg per day, but I got this horrid, painful mouth sore (only one, behind my front teeth--and it made the teeth ache like crazy!). So my rheumy said to increase to 2 mg Folic Acid per day and the sore went away like magic. However, it returned so I went up to 3 mg per day--since then, I haven't had any mouth sores. 

Interesting that your doctor seems to think that mtx is the way to go with PMR. I wonder if he's seen good results with his patients, then? I forgot to ask my rheumy that question! Maybe I'll ask her on Wednesday.  I wonder if it's possible there just aren't any studies on it, but experience shows it is helping people? Maybe doctors in the U.S. are using it more, as you say--I just don't know.  I hope I'm not being a wuss, but medicines scare me!

I hope this doesn't sound like simple venting of my problems....I really hope the information can help other people with PMR.

freesia2
freesia22010-11-15 16:17:20Hi Freesia,
Don't feel bad for venting your problems! When I hear what you're going through it helps me to not feel so alone. Not that I want you to have anything to vent about. This forum is full of folks who understand what you're going through.

I'm happy for you that you made a decision regarding the mtx. My rheumy has told me that it is used as a steroid-sparing drug. Sometimes it to helps people reduce their steroids. It didn't help me at all and the side effects weren't fun. It scared me! When I saw my rheumy last time, she said the dose of prednisone that I'm on now (10 mg.) is considered a low enough dose that the side effects from the steroids are minimal. I hope she's right. I really don't want to take any more medications either.

Good luck with your appointment tomorrow...

Jannie Hi Jannie, and all,

Thanks for your support. Glad I don't sound like I'm whining! And people here all understand.

I had a pretty good appointment with my rheumy today.  As far as the mtx, my rheumy said that most people have it in their minds that mtx is much worse than pred, when really pred has more side effects. (However, it's how it affects YOU that is important, of course.) So we kind of decided that I'd stay off mtx for a month to see if I notice a difference in how I feel. The shift in my liver values apparently is nothing to worry about.

I wonder, have any other rheumies expressed worry over you being on prednisone if you aren't taking bone strengthening medication? I forget if you said you were taking it, Jannie. I've refused to take it because of the esophageal irritation (and I don't really want to take any form of it). My rheumy really is concerned about my bone health because she said even 2 weeks on pred can cause bone damage, and I've been taking it for almost a year. I have to defer to her knowledge...after all, she's the doctor, she knows more than I do about these meds, and I know she wants to help me. But I wonder if some people can take it without it having bone deterioration, while others can't ?  It's funny, after I leave the doctor's office I always come up with questions that I should ask while I am there.

So anyway, as always there are lots of issues to deal with. I also had an x-ray of my spine because I've had problems with my neck, shoulders and right arm since my gardening "incident" on July 4.  All I was doing was pulling a weed from a standing bent over position, I stood up straight and something snapped or popped in my neck or upper back area and has never healed up. The docs are puzzled as to how much the PMR is playing a role in this.

I guess it's hard for me to get used to a lifestyle of taking meds all the time because I've always been pretty sensitive to medications--and until now, I only had diseases that required a course of medication for a few weeks.  I'm sure I'm not the only one !!!
Thanks for listening!
Take care everyone 

freesia2
freesia22010-11-17 20:32:42My rheumy has never suggested using anything for bone strength other than 1200mg calcium & 800mg vitamin D daily.  I have had dexa scans in the pass which came back good so maybe this is why.  I will be due for another one in Feb. 2011.  Normally every two years is the norm for a dexascan.  Have you ever had one?  All they do is scan your lower back and hip areas.  It is very simple and pain free.  In my case they scan my hip & arm since I have metal in my lower back. freesia, I take Evista for extra bone strength.  Have been on it for at least 3 years, and have been on pred for 10 months.  Had Dexa done a couple of weeks ago and spine was actually better than in 2008.  Evista is very easy to take - not hard on esophagus or stomach - for me at least.  Hope you find what works for you!russellcat, that is strange, it sounds like we had similar incidents, although I think yours sounds more severe. For myself, I don't think anything was swollen. My rheumy called me today with the x-ray results and it shows arthritis-like deterioration, worse in my lower neck.  I never knew that arthritis could be so painful, although it does ease up during the day. I told my rheumy "let's not do an MRI" probably because it was 5 p.m. and I was already fading from a tiring day and week! She said we'll watch to see if it gets worse which is fine with me.  I'm sure your rheumy hasn't suggested any bone strengthening drugs because your bones are fine! Be thankful!

I wonder if prednisone has had anything to do with the incident & current condition of my neck and spine-- according to my rheumy, taking pred more than 2 weeks can result in bone deterioration. By the time it happened, I'd been taking pred for 6 months.

A friend of mine took that bone strengthening drug which you inhale and she said her ears turned red every time she took it! I'm sorry about your sister, that sounds really awful, but glad she is doing better now. I've heard of such devastating side effects with some of them, especially the injected one, that I don't want anything to do with them.

ANNUFL, thanks for your input on Evista. Is this the one that is inhaled? I'm glad you have had such good luck with it. My aforementioned friend also showed increase in bone strength .  I'm just so scared of them. I don't understand how they work, or how a drug can make healthy, normal bone to grow.  If I can't reduce the pred, though, I probably am going to have to try something. 

freesia, Evista is not inhaled.  It's a small oval-shaped pill that I take every day.  I had researced it and suggested it to my gyn, because I knew I would have trouble swallowing Fosamax or Boniva.  Both she and my primary care doc think it's great for my needs.  Good luck!Thanks ANNUFL ! Your input on this is helping to open my mind to the possibility.

Meanwhile, today I started on a tapering regime that was recommended here. New dose, old dose, old dose, new dose for a week or two. Then old, new, old, new, etc for another week or two. Hopefully at that point I will be able to manage with the new dose, which is only .5 mg lower than the old!  Hi guys! Mrs E, would 9.5 mg be considered a "lower" dose? I hope so, that would be good news.

Odd that there are now three of us reporting this popping sensation in the back. I wonder if others have had it also? For me, the popping was just the start of a sore neck/upper back that has never gone away.  At first I declined the MRI, after getting x-ray results, but it seems like it might be a good idea, especially since I go to physical therapy, and I feel like the therapist needs to know exactly what is going on--so do I!!!

My right arm, biceps and triceps area, has been sore for longer than I've had PMR, and now the pain is going down to my forearm. I don't know if the methotrexate was keeping this at bay, and now that I've stopped taking it, the pain is worse? I'm hoping to get some imaging finally done. I have been complaining about it to my doctors for so long and it keeps getting put on the back burner.
Freesia - it does seem that the general opinion is that once you are below 10mg a day you are on to a dose that causes less concern amongst the medics. About 7mg they really do stop panicking!! MrsUK keeps pointing out, quite rightly, that as time goes on you are into the "getting older" bracket as well as the PMR one!! Some things, the skin fragility, the sore bits if you do too much and so on, are part of getting that bit further away from 21! Someone asked about steroids and osteo in one thread - the osteo is often wear and tear and, obviously, that worsens with advancing years. All the bits that I had been told are osteo pain have improved since I started on steroids - who knows sometimes which is which? I had bicep pain which trailed down my arm diagonally from the elbow towards my wrist (both arms) and was diagnosed as repetitive strain injury (too much typing) - RSI treatments did help but it went with steroids at a high enough dose and returns if I try to go down from where I am on steroids or do too much (which are actually one and the same thing, the dose is inadequate for the load you are putting on it). I also am sure that there was a "herald" of the PMR that was atypical - like your arm pain. My worst "pop" is lower back but the upper back and left side of my neck are also "issues". It's damp at present  and I know about it - please can I have dry but cold???? It is promised for the second half of the week - pretty please nicely   SNOW!!!!! Ski season!!!!
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