methaxatrate side effects

Thank you Eileen for your valuable input. My liver enzymes were monitored by regular blood tests but he kept saying he sees patients with 3 times the level above what mine is. What prompted me is i was having pain on right side under my breast bone. So my gp said to do an ultra sound even though i had ct scan in october showed nothing. So the ultra sound

Was a detailed test that dissected the liver pattern and thats what showed as liver fibrosis. I am bitter because i never wanted the methotrexate to begin with. I was taking the higher dose if steroids to start with but as you have stated it was to reduce the dose thats why he prescribed it. Yes i am niw going to get another opinion as he has had a whole year. Cant diagnose me treating me withour proper diagnosis and the esr and cpk still high no improvement after all this time. Not to mention how much radiation i have been exposed to with extensive tests...just over it. Now have to see a liver specialist and a gall bladder specialist as prior to this roller coaster i have never been ill nor taken meds.

It is speculation of course, but one cause of liver fibrosis is autoimmune liver disease - and that might possibly be the cause of your persistently elevated ESR and CRP. Was your PMR fairly typical? Was it muscle stiffness/pain rather than joint pain? Otherwise the symptoms are pretty typical of all autoimmune disease!

One drug used to manage liver fibrosis appears to be pred - so you may not have to worry about the PMR! Of course it says they don't like using it because of the long term toxicity - but when you have PMR you don't worry about that so much...

Good luck - and do tell us how you get on.

But Eileen if it is autoimmune of liver how come it only showed up now after 12 months. The muscle stiffness was the main issue I was experiencing to begin with. Why then in October with all the extensive testing did the liver appear normal as well as the other organs. I really believe its the methotrexate that has caused this problem or pehaps the continuous high esr and cpk readings may have now efdected the liver. When I was on a higher dose of steroids the levels did come down but not to a normal level. I am also experiencing really bad i think reflux as at times my throat i cant brrathe. It closes right up. Have had 3 bouts of bronchitis in 2 months 4 lots of antibiotics. I work for an airline and exposed to lots of passengers carrying all sorts of bugs and virusus. So therefore susceptible to everything.

My appointment for liver specialist isnt until may..cant fit me in earlier. Not sure what to do in terms of do i up the ateroid treatment now that i ceased the methotrexate or do i wait to see how it affects me. So confused right now. I am feeling really down and cant seem to get myself out of this. I am trying to stay strong but feeling like crap...

I'm not saying it is - I'm suggesting it must be considered and the evidence you have so far makes it reasonable that it is investigated. If you have one autoimmune disorder you are at a higher risk of developing another and perhaps that is what has happened. Many PMR patients do have raised liver enzymes right at the start - maybe that is a sign that mild liver involvement is common but something that hasn't been noticed because they haven't looked for it. There are many ifs and buts that can't be answered at present, maybe never will be answered.

The high ESR/CRP readings are a SIGN of the damage/inflammation. The haven't CAUSED anything. They are due to the production of proteins by the liver in response to the inflammation somewhere in the body. And they are not the signs that the liver is damaged. The liver is an amazing organ - when you remove the potential damaging substance, it usually regenerates well.

There is little evidence that WEEKLY, low dose mtx is going to cause significant liver damage in the short time you have been on it. It is possible over several years of lower dose use, it is possible when it is being used daily or more often than weekly in high doses for cancer. This is a good discussion of the risks:

Psoriatic arthritis, methotrexate and the liver—are rheumatologists putting their patients at risk? K. Lindsay, A. Gough

Autoimmune disorders are very complex - the muscle symptoms may appear in many different autoimmune illnesses and often there are what are called "crossovers" where a patient has signs and symptoms of more than one "label". The management for autoimmune hepatitis uses pred - but at a higher dose than you would use for PMR. The starting dose you were on was perhaps enough for early stage inflammation - and now you are at a lower dose it isn't enough or the inflammation has increased. It can be quite a time before all the signs and symptoms appear, often liver disease is only found by accident at a late stage.

When you were put on pred it is surprising you weren't put onto either ranitidine/Zantac or a PPI to manage potential reflux and if you have symptoms I'd suggest you not only tell the GP but get some for yourself from the pharmacy if he doesn't offer any.

For the moment I would see how it pans out having stopped the mtx - it may be it wasn't doing anything and you would have been able to reduce the dose anyway. If you continue to feel the muscle pain then trying a higher dose again isn't likely to do much harm - but you do have to be able to keep the prescriptions up, you must not stop the pred suddenly, so you will have to get at least your GP onside until you see the liver specialist to be sure you have the supply.

Of course you are feeling crap - you have been dx'd for a long while with a chronic illness and just as you were coming to terms with that, the rug has been pulled out from under your feet and you are told you have something else. Some thing that potentially COULD be due to the treatment the doctor chose for the first problem.- which does bring an element of mistrust in him.  It is possibly something to discuss with your GP - I don't know much about your system but maybe there is some counselling you can access to help you process this new unknown situation. Not sure more pills are the answer though. 

Thanks ince again Eileen. I have been away abroad for work and just got back. I have the bronchitis return and the reflux has now reached extreme. I am taking nexium 40mg for the last 4 days. Still waiting for it to reduce it. I am literally falling apart. The muscle stiffness has returned. Perhaps the travel and extensive houra of conference etc has made it worse. I stopped the methotrexate on my own accord. My go was able to experdite the appointment with the liver specialist to next week. I am still on 7mg steroids and seeing my regular rheummy firat tomorrow and asking for all my rest and reports so as to get a second option. So glad for your knowledge and support it helps a lot. I will keep you posted with how I travel...