Hi, Methotrexate is an anti-neoplastic and immuno-suppressive agent widely used in the therapy of rheumatoid arthritis along with many other conditions such as lymphoma, solid tumors and psoriasis. When given in high intravenous doses, methotrexate can cause acute elevations in serum enzymes, and long term methotrexate therapy has been associated with frequent but mild elevations in serum liver enzymes and, more importantly, with the development of chronic liver injury, progressive fibrosis, cirrhosis and portal hypertension. Methotrexate is arguably the best option for rheumatoid arthritis and if it has to be continued for a longer period then measures will have to be taken to protect the liver. Concurrent administration of folic acid has been shown to decrease the rate of liver test abnormalities on therapy without apparently affecting the efficacy of methotrexate. Please talk to your doctor as to how to minimize liver damage. Hope I have answered your query. Let me know if I can assist you further. Thanks. Regards, Dr. Prabhash Verma General & Family Physician