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Liver Enzyme Elevations in Rheumatoid Arthritis: Clinical Relevance and Influence on Treatment Strategies
Yahya Atayan1, Servet Yolbas2, Emin Bodakci3
1Department of Gastroenterology, Medical Faculty, Inonu University, Battalgazi 44000, Türkiye.
Journal of Clinical Medicine
|October 29, 2025
Summary
Monitoring liver enzymes in rheumatoid arthritis (RA) patients on methotrexate (MTX) is crucial. Dose adjustments can manage elevated liver enzymes, preventing treatment discontinuation in most cases of RA.
Area of Science:
- Rheumatology
- Hepatology
- Pharmacology
Background:
- Rheumatoid arthritis (RA) is a chronic inflammatory disease affecting synovial joints.
- Uncontrolled RA increases risks of cardiovascular diseases, osteoporosis, and malignancies.
- Early treatment with disease-modifying antirheumatic drugs (DMARDs) improves outcomes but can cause hepatotoxicity.
Purpose of the Study:
- To retrospectively evaluate liver enzyme changes in RA patients before and during treatment.
- To assess the impact of methotrexate (MTX) and combination therapies on liver enzymes.
- To determine how liver enzyme abnormalities affect RA treatment strategies.
Main Methods:
- Retrospective analysis of 33 RA patients' liver enzyme levels.
- Evaluation of patients on methotrexate (MTX) monotherapy and combination regimens.
- Monitoring for elevated liver enzymes before and during treatment.
Main Results:
- 15 patients had elevated liver enzymes pre-treatment; 18 developed abnormalities during therapy.
- 7 patients (21%) on MTX (mono or combo) had persistent elevated liver enzymes.
- 5 patients (19%) managed with MTX dose reduction; 2 (7%) discontinued MTX.
Conclusions:
- Hepatotoxicity in RA patients is manageable with close monitoring and dose reduction.
- Treatment discontinuation due to elevated liver enzymes is infrequent.
- Patients with pre-existing liver enzyme abnormalities on combination MTX therapy require careful monitoring.
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