Starting MTX

[Bill]

Very frustrating, but maybe there is an underlying concern for you. I am sure you will find out. You could always ask to try the DMF. Has worked a treat for me and others, although I am keen to get my hands on some fish antibiotics from Thailand to see whether I can knock down the arthritis a bit more still.

< Finally, coadministration of folic acid has been shown to decrease the frequency of serum enzyme elevations and now is commonly used.

Long term therapy with methotrexate has been associated with development of fatty liver and hepatic fibrosis and, in rare instances, portal hypertension and symptomatic cirrhosis. Symptoms are usually absent until cirrhosis is present, and liver tests are typically normal or minimally and transiently elevated. Routine monitoring of patients with regular liver biopsies done at 1 to 2 year intervals or with cumulative methotrexate doses of 1 to 10 grams demonstrates that approximately 30% of patients develop mild-to-moderate histological abnormalities (fat, cellular unrest, mild inflammation, nuclear atypical) and 2 to 20% of patients develop some degree of hepatic fibrosis. Well documented cases of cirrhosis arising during long term methotrexate therapy have been reported, but cirrhosis is rare in prospective series, even with routine histological monitoring. Patients who develop fibrosis on long term methotrexate therapy often have other risk factors for fatty liver disease, including excessive alcohol use, obesity, diabetes and concurrent administration of other potentially hepatotoxic agents.>

Cheers,

Bill