Yea - MTX is big no-no for liver if you are already showing elevated enzyme levels. But depending on the anti-TNF you are on, you may have risk of forming antibodies to it when you stop MTX. I did so with Humira when they stopped mtx for me. So I had to change anti-tnf drug.

First..inform your primary you intend to fire that Rheumy and get a new one - it would be great if he would participate.. i moved a lot in my career so had to frequently hire new ones. And I fired two.

The second one I fired tried to pass mine off as Osteo because I was sero-negative since diagnosis in NY. But as luck would have it, this time i came back sero positive. So I found another, he put me on remicaid and life has been great since. I occasionally flare and take low dose prednisone for as brief a time as possible. I have supplemented with Hydroxychloroquine but I don’t like it so don’t take that route.

You may have to try two or three to find your magic potion.