What the Liver?!

Ever since I started taking methotrexate, I’ve had a complicated relationship with my liver.

I was a latecomer to methotrexate. It was considered a new drug for rheumatoid arthritis (RA) when I was a teenager with juvenile rheumatoid arthritis more than 20 years ago. We debated whether I should try it—get out the big guns and zap the RA. But at the time, the increased blood tests and risk of liver damage were a deterrent and we decided to stay with different treatments.

When my RA stopped responding to the more traditional non-steroidal anti-inflammatory drugs about five years ago, my rheumatologist asked if I had ever tried methotrexate. It was the next best thing to try, so I anxiously began my new drug regimen with additional doses of prednisone and folic acid to make my liver happier.

The major challenge with methotrexate is the potential for liver damage. Before I started the medication I did some research about these risks and my doctor explained that a daily folic acid supplement would help me to absorb the medication and assist my liver in processing it. I also reduced my alcohol intake to very little, as in a couple drinks per year.

The medication started working after I had been taking it weekly for a month. One day I woke up and realized I felt a little better, then increasingly better with more time. However, almost immediately my liver enzyme levels (monitored through blood tests) began to rise. We dropped down my dosage a little and found a better balance between my liver health and my RA inflammation level.

However, during the next several years my inflammation marker never reached normal and my liver enzymes have periodically flirted with danger. It’s this crazy conundrum of needing more medication to make a better dent against the RA versus risking liver damage. Obviously, neither of the choices are good.

The typical guidance for RA is to treat the disease as aggressively as possible—go full tilt with medications and anything you can throw at it. The common wisdom is that the quicker you can stop the disease, the better you can prevent damage. But what is the practice for a case like mine that is many years in the making, where I already am coping with a great amount of joint damage and disability?

How do I fight the disease while balancing the potential consequences of seriously powerful medications? In my case, methotrexate is quickly becoming a short-term treatment as we weigh options between different medications.

One of the frustrating aspects of having to give up on an effective treatment is that I feel I’m being controlled by my liver. No matter how I tried to treat it well and baby it, my liver seems to have little tolerance for the drug. It holds all the cards—no matter about vitamins and drinking lots of water. It seems like a fictional character is controlling me because I can’t see it or even feel it.

I have to admit, before starting on methotrexate I never much thought about my liver. Maybe this is payback for many years of ignorance and noninvolvement. If only I could talk to it; change its mind; maybe persuade it that certain drugs should be acceptable in extreme cases.

I fear stopping the methotrexate because maybe I’ll feel worse. Frankly, another drug may not work better. But on the flip side, I won’t know if I don’t try and it’s becoming increasingly clear that long term use of methotrexate will not be an option.

In the meantime, I’ll wait to take my next blood test and ponder the question: what the liver?!

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The RheumatoidArthritis.net team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

Comments

View Comments (4)

Poll