Liver Enzymes elevated--Need advice!

General
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I got a call yesterday that my liver enzymes are elevated for the first time and my rheumy needs to see me ASAP–which is in 3 weeks because that is his first available appt. Needless to say, I am a little nervous and need your collective advice. My AST-SGOT is 41 (it has never been above 23 before) and my ALT-SGPT is 43 (it has never been above 17 in the past).

I was diagnosed October 2014 with PsA. I started metho (15 mg oral) January 2015. I currrently take 20mg metho injection, which starting this weekend becomes 15mg, along with Humira.

The first thing I did after getting diagnosed was hire a personal trainer. My goal has been to be on the lowest doses of medication I can while controlling my disease. I lost weight, gained muscle, and now weigh what I did 25 years ago but I am in better shape with more muscle. I am on an anti-inflammatory diet and see a chiropractor/physical therapist who has had issues herself and is helping with my nutrition, too. I am currently taking some supplements–curcumin (tumeric), l-glutamine, reacted magnesium, and a good multi-vitamin.

I am a teacher, and I take that to heart. It is so stressful to me that I have already told my principal that this is my last year. I need a less stressful job, one I don’t lose sleep over. That reminds me–I am not sleeping well and starting to go through the “change” with very frequent hot flashes. I turn the big 50 in March.

Please help me put this into perspective.

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Hi Zinnia.

Your levels don’t look too bad at all. Looking through my old blood test printouts (I don’t bother with them anymore) the upper normal level for ALT is 45 u/L. As for AST, seems I wasn’t tested for that, but a quick google suggests 40 u/L as the upper normal. As I understand it, these ranges are really just a guide and going a few points over may not mean anything much.

There again, the rule of ‘normal for you’ may apply and I’d speculate that this is why your rheumy wants to see you. A site called Lab Tests online does suggest that vigorous exercise may increase AST levels.

I’d say don’t worry about this while you’re waiting for the appointment. I had ALT in the 80s for over a year a while back and even that wasn’t considered particularly high. However as it persisted I had a liver scan which showed that my liver was in good nick! I then re-started Mtx and haven’t had problems since.

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Thanks, Sybil! I feel better about it now. It seems that PsA always throws new wrinkles at you to make sure you know it is still there just when you think it is under control. First it was eye infections that concerned my rheumy–and me, too. Now this. I have to find a way to be concerned but not overly so. Stress is not good!

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Exercise, vitamin supplements and yes fluctuating hormone levels all can effect liver levels. But believe it or not low med levels can do the same. Here is the problem with keeping med levels low. You have minimal disease control as well which also effects liver function. Your pain may levels may be okay but thats as far as it goes.

What folks who are on the edge end up doing is without even thinking about find they are bit achey one night especially after a “good” workout so they pop a couple tylenol, advil etc for a good nights sleep. perfectly logical EXCEPT a single OTC dose of an NSAID is enough to work the liver a bit more and send those enzyme levels even high than yours (temporarily)

A hot flash does the same… and believe it or not A healthy diet will too. Most healthy diets replace carbs with either protein or even fats which are metabolized differently Not to mention curcumin confuses the gal bladder for a while.

My guess is your Doc will repeat the levels to see what has happened recently. usually they are back down Keep a good diary of not only food but everything that passes your mouth especially supplements and any OTC drugs. Most vitamin supplements theses days are high in B complex, in fact nutritionist often recommend higher levels of B (and more recently B3)

Also FWIW the “change” can be a huge factor … Before menopause, women usually need about 18 milligrams (mg) of iron each day. After a woman stops menstruating, that requirement goes down considerably to about 8 mg of iron a day. More will spike liver enzymes.

On another note don’t be in a hurry to swap jobs if you really love what you are doing… Most end up regretting it as they usually do get through the adjustment times with PsA and wonder why they quiot. Maybe job sharing for a while or Title1 tutor??? Its hard to for experienced teachers to get back in, in a lot of markets these days. In any event You really as Sybil said are nowhere close to needing to push the panic button quite yet.

I would suggest a visit with your Gyno. HRT is a pretty good option for PsA patients as steady hormone levels does result in result in better disease control. You are doing so many things right and making great decisions, I know you will get this thing.

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Thanks, tntlamb. You have given me a lot to think about. I very, very rarely take OTC drugs besides my daily allergy pill–which I tried to quit but the symptoms came back. I had decided against HRT, but maybe I need to reconsider.

About my career–I am looking for opportunities outside of having a classroom–like tutoring at a Title I school or even private schools. I just know that for the past two years my trainer has noticed a significant increase in my inflammation when school starts. It goes down again in the summer–even when I am taking college classes to get endorsements on my certificate. I am renewing my certificate to keep options open.

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So glad you’re feeling a bit less worried Zinnia. I have to ask, how does your trainer gauge your inflammation?

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I’ve been out of full time teaching for quite a while now. Originally I left bc of my kids, but just can’t do it now. It’s just too much. That said, I’ve been working all along. I did online teaching for about 14 years, and started doing dog walking/pet sitting about 4 years ago. Put kids on the bus in the mornings for a few years but that’s done now.

I could make a lot of money tutoring privately, but my teenage daughter is mentally ill, and I can’t commit to being out of the home most evenings. Instead, I picked up doing homebound tutoring this fall. I’m doing 4-6 hours a week, and I’m loving it! That’s on top of the dogs and other pet sitting. I have an excuse to look a bit nicer when I go out to tutor, and I’m really using my brain. I’m mostly tutoring math, with a few science sessions here and there. It’s also a chance to prove to my daughter that I DO know what I’m talking about with geometry, since people are paying to have me tutor it.

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My enzymes stay at that level. They were a little higher because of the methotrexate, went down when switched to Humira. I did get referred for a liver biopsy after 3 abnormal levels…it was normal. My new normal is elevated, just like my new normal for pain stays at 3 or higher😳

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Stoney, it has been a hard decision to leave the classroom. I have thought about it every year since I was diagnosed–first because of fear of getting sick all the time. I actually get sick less now, I think. Now I can see the change in my body when the school year starts. The inflammation and constant pain in my shoulder, wrist, and fingers. The hip and ankle inflammation and pain that comes and goes. I even reduce metho in the summer. And I work hard every summer at a restaurant and rarely show symptoms. I even sleep well in the summer. I just need a job that I don’t bring home with me. It may be as a pull-out teacher at a Title I school. Maybe a part-time job in the mornings and tutoring in the afternoon. Maybe something totally different. Thankfully my kids are grown and my husband makes enough that I can make less. I need to look at what is best for me long term. Stress is my trigger and I need to control it to control my disease.

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Krim, I think it is strange that my levels suddenly elevated. My levels are usually in the teens, now they are suddenly in the 40s. It is a relief to see that others stay at that level and that I may have overreacted. PsA continues to change how it attacks and keeps me guessing. I am lucky to have little pain in the summer. However, it is constant once school starts. Thanks for sharing–it really helps!

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Hi Zinnia, my last levels were very similar (mine are just below upper level of normal) and I’m usually in the teens too. My doctors seem not to have really noticed - from what I’ve read it’s really when you start getting to 3x to 5x the upper level of normal that alarm bells start ringing.

As my docs didn’t notice, I figured I’d get my bloods re-done in a month or so and if they have gotten any higher make an appointment with my GP.

As my medication is generally pretty effective, I’d hate to change it for some transient blip! Here’s gaping they come back as usual for both of us next time :blush:

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Jen75, are you on metho and Humira as well?

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Hi Zinnia,

Yep, same combination. Though as I get SEs and no perceived benefit from methotrexate I must admit I’m less compliant than I should be - it is a quirk of the Aus system that you must take methotrexate whilst on biologics unless completely intolerant to it (related to research in RA about antibody development, I assume).

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This thread is really interesting. And I’m so glad Zinnia that it appears it’s not something most likely to overly need to stress about during the wait for your doctor’s appointment.

As a person just on the otherside of the ‘change’ (thankfully) I can certainly identify with increased worry about things and really wanting to try hard to keep my body reacting sensibly and yes the job issues too and dealing with the onset of this incredibly complex disease, which appears to twist and change in the oddest of ways and always by surprise. Dealing with that and also the menopause isn’t fun at all.

One thing really struck me Zinnia though which might be something to think about is how stress and you interact. I’ve spent the last two years since getting PsA thinking about that for me. I’ve always known since I got just psoriasis aged 13 that my reactions to what I considered to be stressful made a heck of difference to my skin flares. I worked hard at slowly chipping away to make any reaction to what stressed me less negative on my skin. I certainly didn’t get massively proficient at it but I could see a positive difference when I did manage to manage my stress better. I’ve been trying that yet again now that PsA decided to take up residence and can see it having a more positive effect too but it is awfully hard work.

The hard work bit is to truly try and change the path my emotions demand and love to travel (and think they ought to travel usually with a fair bit of indignation too, especially in my case) when I get stressed about whatever it is that dings hard on my stress button. I can of course try to avoid the things that do hit my stress button but actually if I work just harder at my consequent reactions and put more effort in that, I don’t need to spend too much energy running around trying to avoid things, such as changing my job because of x, y or z.

For me this thing called ‘psoriasis whether it’s skin cells renewing too fast or inflammation on joints and tendons etc’ (or maybe that should just be called our collective ‘less than normal immune system’) certainly thinks its best food ever, ever, ever is stress and it tries hard to get as much of that as possible. I do see when I do my really very best to starve of that food, it behaves better. ‘Finding ways to be concerned but overly so’ is for me at any rate the only way forward. Because as you say ‘stress is not good’ but stress or stress inducing things are always going to be there and I can do little about that, but I can just sometimes stop myself ploughing off down that path of ‘being stressed’. One of my major stressors when I got PsA was the meds I was told to take. And I certainly got exceptionally stressed about them and side effects and everything else. I now look at it very differently but that’s only occured within the last few months.

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Try adding milk thistle as a supplement. www.mayoclinic.org/drugs-supplements-milk-thistle/art-20362885

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Poo_therapy, thank you for your response! It is what I love about this site–the ability to connect with people who are going through the same things you are and learn from each other.

I have worked very hard to change my response to the stressors in my life. At the start of this school year I was determined to change my response to stress. I went from working out 2-3 days a week to 5. I would go at 5:30 or later and work out my stress. I did cardio (which I hate), weight training (which I love), and balance training (my very, very favorite). I am so good on a bosu ball or balance board! I ended up in physical therapy because I WAY overdid it because of the way my stupid PsA body reacts to everything. My personal trainer says he has never seen anyone ever overdo it on balance. I have just in the past 3 weeks been released by my physical therapist to do balance and some weight training again, after a couple of months of daily exercises to release muscles and tendons that are angry.

I am also consciously making the decision to be happy. To smile. To interact with others in a positive way. To not complain. To be a positive impact on others. Sometimes this leads to me internalizing the stress, though. Overall, I think it has helped–but not enough to make my job in its current form the best for me moving forward.

I am becoming more conscious of the way my body reacts–to the food I eat, exercise, etc. Menopause is the unknown in all of this. What fatigue, sleeplessness, hair loss, etc is because of menopause and which are because of PsA and the drugs used to treat it? As you said, and I completely agree, PsA ‘appears to twist and change in the oddest of ways and always by surprise’. It keeps me guessing. I try to be aware but not overanalyze.

I, too, used to stress about the meds I was told to take. I, too, now look at them differently. I did finally refuse to continue taking the daily NSAID. I reduced inflammation greatly through diet, exercise, and physical therapy. I am at peace with my current medication plan.

However, tntlamb does make a valid point about how too little meds can affect my future as well. I can see visible changes to my hands in the past year. In the next 2-3 months I will get new ultrasounds of my hands and feet, but I know there is permanent damage. Even with all the diet, exercise, stress reducing, etc.

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Thanks, kmwestmo! I will look into milk thistle!

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I took a look at your link. Regarding the liver, it said, “Liver disease. Research on the effects of milk thistle on liver disease, such as cirrhosis and hepatitis C, has shown mixed results.”

Supplements often don’t have research to support their use, and may have unknown risks, again, because of the lack of research. There is a section on complementary therapies where this type of discussion might be more appropriate. Also, any medication changes or supplements should be discussed with your physician.

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It’s the methotrexate. Also common is fatty liver. Many medications can cause that but if you just started methotrexate that is the culprit. You may need to be taken off it. The dr. will help determine this. Other treatment options may need to be explored. I personally can’t use the stuff–fatty liver.

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Maybe its the MTX , but just as easily its not. Here’s the thing with liver enzymes, there are way too many factors to be quick to narrow them down as the liver does EVERYTHING when it comes to autoimmune disease. Sometimes those numbers indicate a minor problem sometimes not (unless they are really high.) It takes the doc some time to sort it out. Especially when it involves medications. Things simply are not what they seem. There is a story that has been circulating for years Excuse me if it seems crass…

A woman comes in to her doc saying doc I have GI problem. I pass gas constantly during the day. BUT my farts are silent and don’t stink… The doc says, “oh okay well lets try this pill and come back in a week.” So a week later the lady returns and says, “I have to stop those pills. Nothing has changed except NOW my farts really stink.” The Doc say no, "that’s not the case. We now have your sinus problem fixed and need to figure out your hearing problem… " Never forget dealing with PsA (or any autoimmune disease) is really a game of wack a mole.

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