Year: 2026 | Month: June | Volume: 13 | Issue: 6 | Pages: 558-561
DOI: https://doi.org/10.52403/ijrr.20260654
Early-Onset Methotrexate-Induced Hepatotoxicity in Rheumatoid Arthritis Despite Normal Baseline Liver Function: A Case Report
B. Vijay Kumar1, D.S.B. Sarojini Devi2, Dr. Rama Brahma Reddy3
1,2Doctor of Pharmacy (Pharm D) V year, Department of Pharmacy Practice,
3Principal and Professor, Department of Pharmacognosy and Phytochemistry.
Nalanda Institute of Pharmaceutical Sciences, Sidharth Nagar, Kantepudi (Village), Sattenapalli
(Mandal), Guntur (Dis) 522438, Andra Pradesh, India
.
Corresponding Author: B. Vijay Kumar
ABSTRACT
Background: Rheumatoid arthritis (RA) is a chronic systemic autoimmune disorder primarily characterized by symmetric polyarthritis. However, atypical clinical presentations and drug-related complications can pose diagnostic and therapeutic challenges in routine clinical practice.
Case Summary: We report the case of a 52-year-old female who presented with migratory joint pain involving small and large joints, associated with morning stiffness and fatigue. Initial clinical evaluation suggested a non-specific inflammatory arthritis, leading to a delay in definitive diagnosis. Laboratory investigations revealed elevated erythrocyte sedimentation rate and C-reactive protein levels, along with positive rheumatoid factor and anti-cyclic citrullinated peptide antibodies. The patient was initiated on methotrexate-based therapy; however, subsequent monitoring demonstrated elevated liver enzymes suggestive of drug-induced hepatotoxicity.
Intervention and Outcome: Methotrexate was withheld, and supportive management was initiated, resulting in gradual normalization of liver function tests. The patient was subsequently managed with alternative disease-modifying therapy, leading to clinical improvement and stabilization of disease activity.
Conclusion: This case highlights the dual challenge of atypical presentation and potential drug-induced adverse effects in RA management. Early recognition, to careful monitoring, and timely therapeutic modification are essential to optimize patient outcomes and prevent complications.
Keywords: Rheumatoid Arthritis; Methotrexate; Hepatotoxicity; Adverse Drug Reaction; Liver Function Tests; DMARD .
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