A 60 year old male with Rheumatoid Arthritis is on 15mg of Methotrexate for the last 1.5 years, 20mg of Leflunamide for the last 3 months and also on PPI Folic acid. ESR-70 and DAS- 4.7. Signs and symptoms are negligible now except for knee pain; not a distressing quality of life. The patient did not tolerate Sulfasalazine and HCQS.
RFT, LFT and CBC are normal. Suggest the investigations that can detect hepatic side effect(s) at the earliest. Do SGOT and SGPT rise in early hepatic fibrosis? What could be the next step taken?
