Methotrexate Dilemma

I have waited so long for someone to treat me and now this. 

Last summer, for the first time ever, one of my liver enzymes just peeked over the top of the normal limit. I had started pentasa a few months before so I questioned it and both my regular NP and my gi NP said don't worry about it, meaningless, etc etc So I forgot about it.  Well, before I started on methotrexate 5 weeks ago I had my blood drawn. Two weeks later I get a note in the mail to go for repeat AST and ALT as they are mildly elevated. Had the repeat done and one was back under the upper limit and one still slightly elevated.  Then one week later I went for my monthly blooddraw (because I am on mtx) and they come back mildly elevated again.  My rheumy told me yesterday that this has to be sorted out.  I will continue with the weekly doses until my next blood draw and if they are still elevated he wants me to stop taking it (mtx) I told him I know I can't stay on prednisone (down to 5mg and feeling so-so but better than I was before I saw him the first time) and I had high hopes for mtx.  He reduced my pred to 2.5mg for 2 weeks and then off it. 

Called my regular  NP and asked if I had her ok to go off my statin, figuring that was the easiest to go off of.  Her nurse calls back and says she doesn't recommend going off it, doesn't feel like it has anything to do with my liver enzymes (I've been on a statin for about 6 years) at this point, and besides, the elevations are not bad.  Well, the gi NP will never approve going off pentasa and I don't either. So what the heck am I supposed to do?  The 3rd option is to have surgery!  I asked the rheumy if gall stones can do this (I had read they could) and he said yes, sometimes they do. So, guess I'll have to have surgery.  Personally, I suspect pentasa might be to blame as I also think it is messing up my WBC count  But the gi NP said that mildly elevated liver enzymes are not a concern.  

The only other possibility is long term use of diovan and I'm too lazy to look it up. I know my NP would not want me to go off that one.

I'm not going to worry about this till my next blood draw

I have been taking MTX shots for more than a year (?) and my GI want's a liver biopsy done. My liver enzymes are not even evalated, but from my understanding of what was told to me that MTX can shut down your liver.

I think it is time to get your liver checked out, because MTX can be so dangerous to it. (I would not play around with elevated liver enzymes.)
Plus, I would make an appointment with your GP and GI and get this situation squared away.

Thanks

Yes, the pharmacist called the gi doctor about the mesalamine/methotrexate interaction. The gi doctor said it was up to the rheumatologist who said that I was on a low dose and it would be insignicant. The reason I am so eager to go on methotrexate is because although my gut is in fairly good shape on pentasa I have tendonitis/joint pain in my feet. That is the reason I asked tosee the rheumy- the gi office told me they only treat the gut. Prednisone worked great too but I know I can't stay on that forever, or I would.

Navy, my GP and GI think my liver enzyme elevations are insignicant. The rheumatologist, who is prescribing the methotrexate, doesn't agree. The levels are bouncing around the upper level of normal but this is a change from all other liver tests I've had done in previous years. Until last August when one of them went over the upper limit. I started pentasa in May of that year. Interestingly my WBC which always runs between 3-4,000 took a nose dive down to 2.2.

Side effects have been odd. I've taken methotrexate for 5 weeks now. Each time the side effects have gotten a little worse. The last time they lasted from Thursday night after I took it all the way to late afternoon Saturday. I told the rheumy this and he didn't like that. He upped my folic acid. I will keep in mind the water tip. The main side effect I have from it is unsettled stomach. Not exactly nausea, more like intense growling like I am hungry yet food does not appeal to me. Kind of like what sometimes happens in pregnancy (for some)