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Your concern about liver health while on methotrexate is valid, especially with a history of fatty liver. Here's some clarification:

1. AST/ALT Ratio: While an elevated AST/ALT ratio can sometimes indicate liver fibrosis or cirrhosis, it is not diagnostic on its own, especially when both AST and ALT are within normal Show Full Answer

Your concern about liver health while on methotrexate is valid, especially with a history of fatty liver. Here's some clarification:

1. AST/ALT Ratio: While an elevated AST/ALT ratio can sometimes indicate liver fibrosis or cirrhosis, it is not diagnostic on its own, especially when both AST and ALT are within normal ranges. Your rheumatologist's approach aligns with standard practice, as isolated changes in the ratio without elevated levels are not typically concerning.

2. Methotrexate and Liver Monitoring: Methotrexate can affect the liver, but serious liver damage is rare with proper monitoring. Regular liver function tests (as you're doing) are key. Persistent abnormalities or significant trends would prompt further investigation, such as imaging (e.g., FibroScan) or additional blood tests.

3. Fatty Liver: Your history of mild fatty liver could contribute to changes in liver enzymes. However, your vegan elimination diet may help improve liver health over time. It's worth discussing whether additional monitoring, like a FibroScan, might provide reassurance.

4. Remission and Methotrexate Reduction: Being in remission is excellent news! Reducing methotrexate under your doctor's guidance is a common step, and it may further reduce any liver-related risks.

5. Discrepancy in Information: Online sources often generalize findings, which can lead to confusion. Your rheumatologist's focus on trends and overall health rather than isolated ratios is a more nuanced approach.

If you're still concerned, consider asking your doctor about non-invasive liver tests like FibroScan or discussing your lab trends in more detail. It's important to feel confident in your care plan.

 AI-generated responses are not a substitute for medical advice. These services are not intended to diagnose, treat, or cure any condition or disease. Always ask your doctor about specific health concerns.

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