Monitoring the Liver
During the years I have been taking methotrexate, my rheumatologist has always been good about monitoring my liver. It has generally been a good drug for me in that it brought my CRP down to its lowest levels and has helped to manage my RA for a number of years.
However, methotrexate is one of those drugs that requires watching. The primary concern is liver damage, but other issues can arise such as more infections, lung damage etc. I have increased skin sensitivity from methotrexate so am very careful to cover up when going out in the sun and use lots of sunscreen for protecting my skin.
While individual reactions and side effects to methotrexate may vary and it is good to be on the lookout for any changes that you feel, regular liver check-ups are definitely required while taking the drug. My doctor orders liver function tests via blood draws every couple months.
During some periods of time, my results have been on the cusp or slightly above the “danger zone” marker. While we decided this was OK for a short period of time, it is dangerous to have high liver function tests because it can damage the liver and may result in permanent harm.
When I have had flares or my recent increase in RA activity, we have increased my methotrexate that has resulted in higher liver function test results. It has been a delicate balancing game over the years to see how high I can go up on the drug dosage without sending my liver skyrocketing. At one point I was on a higher dose, then when we added a medication the combination did not agree with my liver, and we had to readjust again.
At my last rheumatology appointment, my doctor decided that I should have a liver ultrasound. His reasoning was that I had been taking methotrexate for a number of years and at some points had experienced high liver function test results. He wanted to take a peep at my liver to make sure it was doing OK and also use the information to guide us in future medication planning.
I made my ultrasound appointment and a few weeks later prepared to go in. The process was fairly easy and painless. I needed to fast starting at midnight, so no breakfast or even water before having the test. I made the appointment for 8 am so that I could get it done and then grab a bite to eat.
The whole test did not take long at all. I laid down on a gurney and the technician spread gel on my abdomen, then glided an ultrasound wand over my belly. She also looked at my kidneys, pancreas, and gall bladder as part of the test. I was instructed to hold my breath at various points so she could capture the still images and sometimes she had to press down firmly with the wand, but otherwise, it did not require any effort on my part.
Later that afternoon I received a report that my liver appeared normal and that I did not have any signs of damage. I was relieved to receive the “all clear,” but also glad to have the test and know that my medications were not harming my liver. This gives me some latitude in my medication planning and any adjustments I may need in the near future to manage my disease.
Since I find that methotrexate works for me in treating my RA, I will continue using it. But I will also continue checking my liver function levels and being mindful about potential harmful side effects. While I need my RA medications to manage daily life, I also need to balance that against my overall health.