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NSAIDs and elevated liver enzyme levels

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In recent two months, liver enzymes have been increasing, AST now > 250. As a result, I have been told to stop Methotrexate, paracetamol, diclofenac, and the statin. I am allowed 500 mg naproxen sodium bid and topical steroids. The plan is to try another DMARD once liver enzymes stabilizes. My rheumatologist has applied for government funding of anti-TNF biologic therapy.

My question is what are my pain reliever/NSAID options that are not associated with liver irritation. I'm doing ok right now but I'm very anxious about having no options if my symptons get worse before my liver improves. At the same time, I don't want to do anything that will make my liver enzymes high because that prevents switching DMARDS.


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replied November 28th, 2008
Arthritis Answer A4999
Current medical status: Diagnosed with PsA 1 year ago. Had 20 year history of mild plaque psoriasis on knees and elbows. Prior to arthritis symptons developed psoriasis of face and genitals. Arthritis progressed slowly after worsening of skin condition. Currently have dactylitis of 4 toes and 1 finger; enthesitis of right heel and left knee. Enthesitis of 1 vertebra.
Current medical treatment: Treated for 9 months with methotrexate, reaching dose of 20 mg once/wk subcutaneous. Seemed to provide significant improvement in joints, skin and nails. Paracetemol 650 tid, diclofenac 75 mg bid. Also take simvastatin 20 mg od and androgel (topical testosterone 1%) 5 g / day.

The Non-Steroidal Antiinflammatory drugs (NSAID) you have been taking decrease the pain by decreasing the inflammation. No other pain reliever can decrease the pain so efficiently and not decreasing the inflammation at the same time.

Unfortunately, all NSAIDs can cause hepatic symptoms including increased liver enzymes. Furthermore, Non-Steroidal Anti inflammatory drugs should be used with caution when administered concomitantly with methotrexate, because they can enhance the toxicity of methotrexate. Liver enzyme elevations are frequently seen after prolonged use of methotrexate. They are usually transient and asymptomatic.

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