[Drug-induced liver damage caused by antirheumatic drugs--antirheumatic therapy in pre-existing liver damage]

In about 1% of patients treated longterm with nonsteroidal antiinflammatory drugs severe liver damage occurs with an increase of transaminases of more than eightfold. Therefore, measurement of the liver enzymes every 4 to 8 weeks is mandatory. When the transaminase values are greater than 60 U/l, the therapy must be discontinued. Methotrexate may also induce an increase of the transaminases, especially within the first 3 months of therapy. Severe hepatotoxicity, however, rarely occurs. Therefore, transient increases up to 60 U/l may be tolerable, but persistent transaminases higher than 60 U/l require termination of methotrexate therapy.