I am suffering of rheumatoid arthritis and I am regular with my prescribed medications. I did my follow-up tests and my liver enzymes were elevated. What does that mean?
If you are using a rheumatoid medicine that is known to sometimes result in a transient elevation of the liver enzymes, and considering that your doctor did liver enzymes tests for you before starting treatment and they were normal and you are not known to suffer of any liver disease, therefore, in this case, we will consider that the elevation in the liver enzymes is due to the treatment that you are using for rheumatoid arthritis.
Is this a problem?
No, it is not a problem. In fact, elevated liver enzymes due to a medication prescribed for rheumatoid arthritis is an everyday exercise for your rheumatologist and he knows how to handle it very well.
All you need here is not to worry and to be assured there is nothing serious at all going on.
Why the liver enzymes got elevated?
The liver is like a large laboratory with a large number of employees working in that laboratory. One of the important functions of the liver is to detoxify and neutralize medications that we drink, like rheumatoid medications for example.
If any extra work is needed to do this job, the liver might need to call more staff members to participate. It might call the on-call staff to come and help. The arrival and participation of the on-call staff in this case reflects itself in an elevation of the liver enzymes.
They do their assigned work and then finish and go back home. Their going back home reflects medically in a return of the liver enzymes back to normal over days or a couple of weeks.
What should the patient do in order to discover and deal with elevated liver enzymes, if it occurs, without delays?
The patient is required to do his/her regular follow-up labs as requested by their rheumatologist. This allows the rheumatologist to discover any elevations in liver enzymes and deal with it according to the known recommendations.
Make sure you don't delay doing your regular follow up labs. For convenience, patients can do the lab tests and send them to their rheumatologist instead of having to show up at his office every time.
I even instruct some of my patients in how to check the figures of the lab results and how to tell if there is a problem that requires communication with me.
How does the doctor deal with elevated liver enzymes due to a rheumatoid medication?
According to his assessment, what the doctor does here is one of three things:
One: He will do nothing because the elevation was slight and thus the enzymes will become normal within days without any actions.
Two: He will temporarily reduce the medication dose until the liver enzymes become normal again.
Three: He will temporarily withhold the medication until the enzymes return to their normal levels, and then restart the medication once again.
So we will not stop the treatment permanently?
Rarely do doctors do this and this would happen in the event that this problem recurs with a certain medication repeatedly and becomes resistant to resolution.
What are the sequels of elevated liver enzymes if the patient ignored it or if the patient did not care to do the regular checkups?
A temporary increase in liver enzymes, even if it lasts for weeks, is not a problem at all as long as we diagnose it and deal with it. As for the persistence of the problem for months and years without care and attention, this may lead to a negative impact on the liver and its functions and of course we don't need that.
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This post was prepared and published by Dr. Hatem Eleishi. Dr. Hatem Eleishi is a professor of rheumatology at Cairo university (Egypt) and is especially dedicated to supporting arthritis patients with online educational videos and articles about arthritis causes and treatment. He also runs a rheumatology clinic in Cairo and a center for online medical consultations that, in addition to providing online rheumatology consultations, also provides online medical consultations in several different medical specialties by expert consultants from Egypt, Canada and the United States.
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