| #ffffff;" /> | | | | adjusted upward. |
| Methotrexate is the most commonly used | | | | At our center we used to extend monitoring out to six |
| disease-modifying anti-rheumatic drug (DMARD) used | | | | weeks but discovered that some patients got into |
| in the treatment of rheumatoid arthritis (RA). While it is | | | | trouble during that period so we went back to a 4 |
| extremely effective, it has potential side effects. | | | | week schedule. |
| Among them are reductions in blood cell counts | | | | Liver function tests ensure that the liver is functioning |
| (particularly white blood cells and platelets), mouth | | | | properly. Aminotransferases (ALT and AST, also |
| sores, skin rashes, fatigue, gastrointestinal upset, and | | | | known as SGOT, SGPT) and albumin are the most |
| liver toxicity. | | | | important tests to watch. |
| When methotrexate was first introduced in the early | | | | If the tests are abnormal, then by holding the |
| 1980’s, concern about the potential for liver | | | | methotrexate, the blood tests should normalize. We |
| toxicity prompted many rheumatologists to order liver | | | | usually repeat abnormal test 2-4 weeks after an initial |
| biopsies before treatment and during treatment. Over | | | | abnormal reading. Many things other than |
| the intervening years though, it has been apparent that | | | | methotrexate can cause the liver functions tests to |
| the potential for liver toxicity is not as great as once | | | | rise. For example, sometimes viral infections can do |
| thought. | | | | this. Also, taking acetaminophen for pain can cause |
| However, liver toxicity is not something that should be | | | | these abnormalities. Other drugs such as cholesterol |
| ignored. This is particularly true since significant liver | | | | lowering drugs can also cause this problem. |
| function abnormalities can occur without symptoms! | | | | Supplementation with folic acid- usually 1-2 mgs a day |
| Careful monitoring of liver function through the use of | | | | can also reduce the incidence of liver function test |
| blood tests is the best way to know if something | | | | abnormalities. |
| serious is occurring with liver function. | | | | Liver biopsies are rarely performed nowadays, but in a |
| Side effects such as cirrhosis are rare but can occur. | | | | patient who has chronically elevated liver function tests |
| Liver function tests should be monitored at least | | | | for which there is no ready explanation, a liver biopsy |
| monthly and more frequently when the dose is being | | | | can provide important information. |