Some people with rheumatoid arthritis (RA) can have elevated liver enzymes. This may be due to the effects of RA on the body, side effects from RA medications, or both.
Having RA doesn’t always just affect your joints. Sometimes, other areas of the body can be affected as well. One of these areas is the liver. People with RA can have elevated liver enzymes.
Elevated liver enzymes can signal that something is stressing or damaging the liver.
Keep reading to learn more about how RA affects your liver, what causes elevated liver enzymes, and if you should seek treatment if you have RA and elevated liver enzymes.
Liver alterations in people with RA can be due to different factors, such as RA disease activity and the effects of RA treatment.
RA disease activity
RA is an immune-mediated condition. This means that levels of inflammation can be increased in the body, affecting various organs and tissues.
Research from 2023 looked at the effects of RA on the liver using several different models. It found that:
- Compared to healthy participants, those with RA had significantly higher markers of inflammation in the body as well as altered markers related to liver disease.
- Participants with RA were at a higher risk of fatty liver disease. This was associated with levels of inflammation and autoimmune disease activity.
- Laboratory exposure of liver cells to RA autoantibodies led to an increase in markers of inflammation.
- In a mouse model of RA, the disease boosted levels of inflammation, fat accumulation, and scarring in the liver.
Effects of RA treatment
Treatment for RA typically includes the use of disease-modifying antirheumatic drugs (DMARDs). These drugs help reduce inflammation in the body and lower RA disease activity.
However, some DMARDs can damage the liver over time. A
Methotrexate use also has
The effects of increases in inflammation and autoimmune activity in RA can place additional stress on the liver. And the use of some DMARDs for RA can also damage the liver. This may show up as high liver enzymes.
When you have tests to look at liver function, the levels of different liver enzymes are measured. These include:
- alanine transaminase (ALT)
- aspartate aminotransferase (AST)
- alkaline phosphatase (ALP)
- gamma-glutamyl transferase (GGT)
The levels of these different enzymes can tell your doctor different things. Elevated ALT or AST signals that liver damage is occurring.
Methotrexate is believed to
High ALP and GGT are associated with cholestasis, a condition where the flow of bile from your liver is reduced or blocked. Over time, chronic cholestasis can lead to liver damage. Researchers have
Cholestasis is also a sign of the autoimmune disease primary biliary cholangitis (PBC).
Rheumatoid arthritis and nonalcoholic fatty liver disease
Nonalcoholic fatty liver disease (NAFLD) can cause elevated liver enzymes and liver damage. There’s a possible link between RA and NAFLD. While this may be due to the effects of RA or its treatment, more research needs to be done.
One study, presented at the American College of Rheumatology Annual Meeting in 2016, found that current methotrexate use was associated with higher rates of NAFLD in people with RA.
However, other than this, the chance of NAFLD in people with RA was linked with similar risk factors for fatty liver disease in the general population, such as metabolic syndrome and diabetes.
If you have RA, your doctor will periodically want to monitor your overall health and RA disease activity. It’s possible they may find elevated liver enzymes during this routine blood work.
If you have elevated liver enzymes and are at risk for liver disease or currently have liver disease, your doctor may use a DMARD other than methotrexate to treat your RA. Some examples include biologics or JAK inhibitors.
Your doctor may also recommend lifestyle changes to promote liver health, including:
- engaging in regular physical activity
- eating a balanced diet
- reducing or eliminating alcohol consumption
- getting vaccinated against hepatitis B and taking steps to avoid contracting hepatitis C
- being aware of medications or supplements that can stress the liver
- taking steps to manage your weight if you have overweight or obesity
Other autoimmune disorders that cause elevated liver enzymes
RA can cause elevated liver enzymes in some people. Having elevated liver enzymes signals that your liver is stressed or damaged.
Elevated liver enzymes may occur due to the effect of RA on the body, the effects of certain RA treatments, or both.
If you have RA and elevated liver enzymes, your doctor may switch you to a medication that doesn’t stress the liver as much. They’ll also recommend that you adopt lifestyle changes that promote liver health.