Seven Years on MTX and No Liver Biopsy

Seven Years on MTX and No Liver Biopsy
from Tracy A.

Hi Ed! I was reading your mail and was struck by the number of liver biopsy stories. I have been taking methotrexate (injections and now pills) for my psoriatic arthritis for nearly 7 years now.

My first rheumatologist brought up the idea of a biopsy after the 3rd year I was taking weekly injections. We mutually decided that we could put it off another year because I do not smoke or drink and I am in relatively good shape. I stopped treatment for one year while I was pregnant with my last child. (Unlike my first three pregnancies, my psoriasis exploded out of control with my fourth.) I have been seeing a different rheumatologist for nearly 2 years now (because of a move) and he has me taking methotrexate orally.

We have never discussed a biopsy and frankly I haven't wanted to bring it up! Does this sound normal? Part of me wants to bring it up and part of me wants to forget about it.

I love this website, Ed! I am sorry that there are so many people in the world with this terrible disease, but I am glad to be able to read and learn from their experiences. Keep up the good work! -Tracy A.

*****

Ed’s Response: There seems to be some growing pains being experienced in the dermatologic community these days. One correspondent writes that liver biopsies in England have been replaced with a new blood test. My own derm acknowledges knowing about this blood test but, evidently, the U.S. medical establishment hasn’t yet sanctioned the replacement. And, for years now, lots of rheumies have been of the opinion that derms go overboard with the biopsy business. Maybe we’ve written so much about them here because they’re such an unwarranted waste of time!

What we really need to know, and I don’t know if anybody does know, is how many courses of MTX therapy have been STOPPED because a liver biopsy discovered something the usual blood tests didn’t show.

I trust, Tracy, that your rheumatologist is doing the occasional blood work to determine if your liver enzymes are in or out of whack. If that’s the case, and you’re passing those tests without a problem, I’d consider the fact that you’ve not been submitted for a liver puncturing a blessing not to be challenged!

But if you did decide to challenge it, here’s what I’d suggest you say to your current rheumy and/or derm: “Oh, I want to thank you for not making me have one of those liver biopsies. I’ve come across some weirdoes on line that seem to be fixated on them!”

Good luck! -Ed