So I have been on MTX and Plaquenil for 3 years now. This along with Mobic (Meloxicam); Tramadol; Tizanidine had finally started doing what they were supposed to do. Then in July I had surgery and subsequent infections and have been off MTX/Plaquenil/Mobic since. In May my SGPT started elevating and even without my meds were still elevated. So just finished a round of prednisone and can start back on my Plaquenil next week. However, I have to stay off of the MTX and Mobic until I have a normal SGPT...If doesn't come down will have a liver scan and switch to a biologic. Now my confusion is the info he gave me on the biologic still says they can affect liver function. Hence my dilemma why change to another med that may do the same damage to the liver?
There are a few here that will know the details really well, but my very limited understanding is that the way MTX affects your liver is very different to the way the biologics do. First thing first, MTX will damage your liver, full stop. The mechanism of injury is direct toxicity, and can be reduced with folate supplementation. For most of us, only a tiny amount of damage will happen over a significant length of treatment, and the risk is worth the return. For a very small number of people, it can cause acute liver damage, and needs to be discontinued.
On the other hand, biologics very rarely cause a raise in some liver enzymes, which is usually transient and elf resolves, and only extremely rarely does it cause acute liver injury. It is believed the mechanism of acute liver injury is autoimmunity. Very rare, and most people never have any sort of negative affects on their liver from biologics.
ALL, and I do mean ALL medications effect the liver. I can not think of any medication that does not list possible liver damage a side effect. So does everything we eat or ingest. The liver is nothing more than a big filter that takes everything out of the blood that doesn't belong there. The difference with the DMARDs you are taking and other drugs is that they (MTX and Plaquenil) are toxic. If you look at your treatment summary/plan you will (or should see) a diagnostic code (V58.69)
I frankly am a bit surprised that they are still using "triple therapy" for you. "Triple Therapy" has been found to be as effective as biologics for RA, not so much for PsA. The reason its so common I'm sure is geographic location. Where ever there are high concentrations of Medicare patients, you find more "Triple Therapy" Its pretty hard top get biologics (except remicade) approved under medicare (same with medicaid) However it becomes easier when the re are bad liver numbers......
Thanks Jen and Lamb for the great info and insight into my confusion. Your responses do clear things up for me. Yes, Lamb, I am in FL and we are the Medicare capital of the world!
Jen, I will look into the NIH site for research.
Thanks again you two.
Had my labs drawn Monday so will see what happens this month.