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Years on MTX and No Liver Biopsy
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.
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
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.
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
Further reading: My Liver Biopsy