Rheumatoid Arthritis & Elevated Liver Enzymes

Rheumatoid arthritis is an autoimmune disease that is treated with a variety of medications, including non-steroidal anti-inflammatory drugs, or NSAIDs, and disease modifying anti-rheumatic drugs, or DMARDs. Many of these medications can cause elevated liver enzymes and liver complications and require you to have regular blood tests to check your liver enzyme levels. If you have rheumatoid arthritis and take any of these medications, it will be important for you to have regular visits with your physician and routine blood tests. If elevated liver enzymes become a problem, your medications many need to be adjusted.

Is This an Emergency?

If you are experiencing serious medical symptoms, seek emergency treatment immediately.

Rheumatoid Arthritis

Rheumatoid arthritis is a long-term and debilitating autoimmune disease that causes inflammation in the joints and surrounding tissues. According to the National Institutes of Health, rheumatoid arthritis occurs when the body’s immune system turns on itself and attacks the synovial fluid around the joints. The feet, ankles, knees, fingers and wrists are the joints most often affected. RA is typically treated with NSAIDs and DMARDs.

Liver Enzymes

Liver enzymes are present in liver cells and are spilled out into the bloodstream when there is an injury or illness to the liver. If you suffer from rheumatoid arthritis and are taking medication to treat your disease, you will be routinely tested for liver enzymes. If elevated liver enzymes become a chronic problem, your doctor will need to adjust your medication dosage or change your medications completely.


Non-steroidal anti-inflammatory drugs include such over-the-counter medications as aspirin, ibuprofen and acetaminophen. They are also the most prescribed medication for treating forms of arthritis, according to the American Academy of Orthopaedic Surgeons 1. They work by preventing the enzyme cyclooxygenase, or COX, which comes in two forms, from doing its job. COX-2 inhibitors like the drug Celebrex work only on the COX-2 enzyme that stimulates inflammation. NSAIDs can cause damage to the liver, especially if alcohol is consumed as well. Regular blood tests need to be taken to monitor your liver enzymes.


Disease modifying anti-rheumatic drugs are a variety of medication that are used to treat many autoimmune diseases and arthritis. They can include medications such as:

  • methotrexate
  • a low-dose chemotherapy drug; hydroxychloroquine
  • an anti-malaria drug;
  • drugs like Enbrel
  • which are known as tumor-necrosis factor
  • or TNF
  • inhibitors

All of these medications can cause damage to the liver and increased liver enzymes. Let your physician know before starting these medications if you have any history of liver disease. Follow your physician’s prescription for these medications and have your liver enzymes tested on a regular basis.