My latest visit too my rhumey,I was told my liver enzymes were high.They didn't really say why,just asked if I was a heavy drinker.I haven't had a drink in 2 months and before that maybe 2 during the week and a couple on weekends.The only thing that comes to mind is the meloxicam.I was on 15mg a day for 2 years straight and before that I lived on ibuprofen.I am on the NSD,I don't think that has anything to do with it,and without it I wouldn't be able to quite the NSAIDs. Been 2 weeks since my last dose and I feel pretty good,and I just got an injection in my hip which helps.

My rhumey won't stop pushing me to start enbrel.He insists I'll feel a ton better.But the side effects concern me.I told him about the NSD and I am in fact feeling 75 % better while on the NSD,and in recent days after quitting coffee.I think I hit another level of the diet.I'm virtually pain free except my hip.

I'm hoping the NSD will slow the destruction that is starting in my right hip now.My left will have to have a total hip replacement soon.I see a surgeon next month.I need to make sure I can still climb a ladder after the replacement.

Should I listen to my rhumey and start enbrel or am I asking for more trouble in the future?My SI's are fusing as well.I've had back problems my whole life.Everytime I see my rhumey I just leave more confused then before I went.

Thanks for listening
Tim.

for years people associated liver disease with alcohol (over)use. now i think they realize that more people have NAFLD (non-alcoholic fatty liver disease) than liver problems due to alcohol use.

my liver enzymes have been elevated the last few years. i got them down a bit, then put on more weight, and back up they went. mine, i'm 99% sure is due to NAFLD from insulin resistance. the insulin resistance, diabetes, and even cirrhosis of the liver all run in my family. my grandmother died from cirrhosis of the liver due to NAFLD and my aunt developed it when she was 50. i have the insulin resistance, have put on some weight (now up to ~150 lbs, ~20 of that put on in the last 2 years) and now it seems to be affecting my liver. i say that cause when i put ~15 lbs on 2 winters ago, the liver enzymes went up. when i took ~1/2 of it off, down they went. weight back up, enzymes back up. so now, back trying to lose those pounds.

so, that is one scenario. a common one too. a lot of people have liver disease due to their bodies not being able to process sugar and carbs.

so if this is the case for you, the NSD will only help. so long as you don't eat much sugar either.

on the other hand, mtx can certainly affect the liver.

as can some nsaids.

i was afraid it was the flector patch i need over my SI joint. but the fact that the numbers went down when i lost some weight while still using the flector patch makes me think its not the flector patch. nor the oral nsaids i was on but stopped. as when my weight went back up without the oral nsaids anymore, the enzymes went back up. so for me, seems correlated to weight, not nsaid use. but nsaids can affect the liver.

my doctors have me get the blood work done to monitor my liver enzymes every few months.

i suggest you consider the mtx first, nsaids second, insulin resistance if and only iff it applies to you, and have your doctors have you get the blood work done until you figure it out / they go down.

my gastroenterologist is very thorough. he had me get a bunch of blood tests done to rule out easy to rule out things, like hepatitis, autoimmune, etc. said we'd do a biopsy if needed.

if you can't easily figure it out, see a GI doc or liver doc and have it investigated further.

as for the biologics, that's your's and your doctor's call. though others on here with experience will share their experiences on them. my rheumy and i talk about them and if our current protocol doesn't cut it, i'll consider them. i just want to feel as good as i can with the least amount of medication possible, but first and foremost, i want to feel as good as i can. i've missed out on a lot the 12 years that i couldn't get a diagnosis or treatment. i feel i have a lot of lost time to make up. i don't want to waste any more of my life.

I do both NSD and Simponi. My son also went on the TNF, simponi, for one reason. To protect his hip and yes it did stop the destruction of the cartilage on the hip joint and the narrowing the rheumy was watching on the xrays. Now he has had a surgery to go in and they "sandpapered" the ball of the femur to take off the small bone growth and trimmed up the cartilage he had damaged. We hope this protects his hips and cartilage for the rest of his life.

One day I may wean off the simponi as it is lasting longer and longer as I stay on the diet.

Hi Underhill,

I hope you were sent again for blood work. Sometimes liver elevations can be a one time blip but it's an important thing to follow up. NSAIDs such as meloxicam can be a possible cause. If caught early, the liver can heal.

I think the greatest predictor of disease progression is existing fusion. I've been on Remicade since Nov 2004 and my AS has been incredibly well controlled ever since and I've had no side effects or trouble with the treatment. With your hips being so negatively affected, perhaps it's a consideration to try a TNF inhibitor to see how well you respond. You could carry on with NSD too, since you are finding such a big benefit. There are 4 anti-TNF meds as options to consider if you do choose this route.

Best of luck in your decision-making!
mig

Elevated liver enzymes are not only from drug or alcohol use. A lot of times it's hereditary and can be found in children, with diseases like fructose malabsorption/intolerance, and multiple endocrine neoplasia problems.

Nsaids, Biologics, Ibuprofen, drugs used for pain after surgery, some foods and chemicals, will all cause your liver enzymes to rises. It's a good chance, if your rise in liver enzymes are more resent - it has a lot to do with the present and what is been taken into your body now. If it's been for many years it's most likely hereditary and likely genetics causing it.

All doctors will monitor any biologic you are on - always taking blood work - for elevation in liver enzymes. Why not try - only reason I would say NO is if you have a severe anaphlatic response to sulfites (which is in all drugs here in Canada).

I have been diagnosed with NASH (non alcoholic fatty liver diseases). Liver disease caused by genetics runs in my family. Allergies/fructose malabsorption-intolerance/multiple endocrine neoplasia (pancreas (diabetes), adrenal(CFS), (allergies), thyroid (severe weight gain/weight loss), parathyroid (http://parathyroid.com/parathyroid-symptoms.htm), and pituitary (unable to smell), (cognitive problems), (problems with sight). All these things will cause imbalance in hormones, elevation in liver enzymes, further problems for the endocrine system and the liver.

Hugs
Gerri & Makaylah

I have a severe allergy to Sulfa drugs. Sulfasalazine almost killed me and put me in the hospital for three days. I take Simponi with no problems however.

sulfa and sulfites. I wonder if there is a difference

Sulfa and Sulfites are totally different

Sulfa is a antibiotic

Sulfites is a preservative

It doesn't help when your allergic to both.

Hugs
Gerri & Makaylah

Thanks for all your input guys ,It's much appreciated.

I go for more labs this month.The latest test was done in April,but I had just seen my rhumey last week to get the results.
He hasn't talked about any TNF inhibitors or any other biologics,except enbrel.I guess I'm a prime candidate for the drug.I am on synthroid as thyroid problem run in the family.

My brothe has had a quadruple fusion in his neck(well after three surgerys),and his lower 2 disk are self fused,and a tone of other problems.My other brother has had a fusion in his back,and arthritits.My dad need a hip replacement and has a herniated disk in his neck with arthrititis.

I believe as runs in our family.I'm just waiting for them to get tested for the Hal-b27 gene.I don't think it's a coincidence.

Thanks
Tim