Biopsy: How often?

[HypoKondriac]

How often do most docs recommend biopsies? My hepatologist is recommending once every 5 years.  

I am a 63-year old female - also have RA and am on no treatment for HCV.

HCV RNA: 10,376,000 IU/mL (RT-PCR).

My rhuematologist is all concerned and afraid to treat me with the meds i need: Humira and methatraxate.

[Kristina538]

Hi Brian,  Welcome to the forum!!! You've put your post on the end of a 2008 thread, and may get a reply if you start a new thread.   I haven't had a transplant so am unable to assist with your question;  I do know that enzyme levels show only the state of inflammation, not the state of the liver, and I would be wanting more answers from my doctors, or trying to research more.   There are a few people on this forum that have had transplants, but there is also the Transplant forum which may be helpful to you.   Best wishes for getting some answers.

[bumbc]

I received a liver transplant 8 months ago and obviously been looked after carefully. Recently my liver enzymes have elevated. With this my Dr.'s requested a biopsy which showed signs of Epstein-Barr Virus. Anyway it has only been three weeks since and my enzyme levels are moderate , but Dr's are asking for me to get another biopsy. Does anyone else feel that this is overkill? Two biopsies in less than a month. I don't have nor do I make the money they do to have these procedures.
Thanks,
Brian C.

[HypoKondriac]

TX again!

my rhuematlogist seems really ill-informed about HCV. he gave me the initial dx like giving a death sentence and is now very freaked about my viral load and worried that meth will make my liver worse.

the latest research i found from good sources says meth is ok. i am bringing him that and also print out that explain viral load and its UNIMPORTANCE in regards to the advancement of liver damage. i will suggest a fibroSURE test.

i was also able to get an appt to see my hepatologist in just 2 weeks!  rheumy wants him to ok the use of meth IN WRITING. i will also ask about increasing frequency of biopsy or at doing fibroSCAN (tx copyman!).

i am grateful to "be" here and get your advise and support.

[copyman]

There is a chance your RA may actually feel better after starting the HCV meds. Once the interferon & riba start killing the HCV that hides in your body including the joints it is quite possible you may feel better. Like Jim said I would jump on board with the Hepatologist and treat the HCV.

[jmjm530]

Not sure what your question or concern is.

What exactly is your rhumetologist concerned about? Is it your HCV or the fact that he doesn't think it's safe for you to go on the mentioned drugs. And BTW your viral load has nothing to do with the severity of your Hep C, if that was the inference.

Do your independent research, but I'd rely more on your liver specialist (assuming he's as qualified as you suggest) in both of these areas as most other specialists know little or nothing about Hepatitis C, including when to treat and what drugs are safe or not.

[HypoKondriac]

Than you. Really   informative!  I was up ALL night th night before last researching RA and HCV. One theory says one ting an one another. The newest journal articles say the methtx is OK to use!

But I'll tell you what. I am 63 and have been being treated for RA for 35 years and it is just getting worse and worse with all the best meds they have for it!  So maybe it is time to take a totally different position.  it is very painful to type this,

But my hepatologist - who is oe of the top in the country says without my liver showing any damage to speak of no sense in going on interferon - which also makes sense, as the side effects are horrendous - including more RA symptoms!  I can't seem to win for losing on this combo.

And with the population aging, and more people dx every day...there are going to be more and more people with all kinds of double dxs!

[Bobby1952]

  If your Dr's did bloodwork before and after administering new drugs then they should be able to tell from your LFT's.  
  Did you ever have a biopsy and if so what is the result.

[copyman]

Hi, I would avoid methatraxate at all costs with HCV! This is the drug that my family concluded killed our father. Ate his liver away. Anyway if you do take it you have to have bloodwork often checking your LFT's (liver function test)
Viral loads tell you nothing and are meaningless unless treating the hepatitis.
Personally I would treat the HCV first and there is a good chance the RA may get better. If not then you could start the RA drugs after HCV treatment with your liver in much better shape.
There are other NON-invasive tests in lieu of a biopsy to check fibrosis.  FibroSURE (bloodtest) & FibroSCAN (like an ultrasound but only available in a few locations in the USA at this time).
Best wishes

[Rockerforlife]

If you are starting a new trial,they want a bx within the last 3 years...i lucked out...i started my new round of tx inbetween that time frame.

[HypoKondriac]

Thanks. My hepatologist - pretty renowned - is very COOL but my rhuematologist is freaked out about it and has been since the day he told me the test results and acted like he was giving me a death sentence.

He's got me up since 4am researching this stuff. It is a conundrum cause what helps one exacerbates the other.  so of course, he wants to be sure that the meds i am having to take for the RA - very heavy duty injectable stuff - is not making my liver worse.

do the viral loads tell us that??? How often do you think those should be done??? are there any other tests short of biopsy that can tell us if th meds are causing harm to my liver and need to be stopped - hopefully BEFORE i develop cirrhosis.

[epiphiny]

I don't know the actual medical protocol on that but I do know that when I was screened for my trial earlier this year I had to have a new biopsy done as my previous one had been carried out 3 years prior.