Sundbaum JK, et al. - From January 2005 to April 2013 at a rheumatology clinic, (Uppsala University Hospital, Sweden), researchers analyzed the predictors of alanine aminotransferase (ALT) elevation in methotrexate (MTX) treated rheumatoid arthritis (RA) patients, and also illustrated the monitoring of liver enzymes, including handling and outcome of elevated ALT. They performed 6288 ALT tests during a mean follow-up of 4.3 years whereas 7% of tests with ALT were more than upper limit of normal (ULN). In 70% of patients who continued treatment recurrent elevations appeared. Similar proportion was observed in those with and without interventions, for example, MTX dose reduction (67% vs 73%). The strongest predictor for early and recurrent ALT elevations during therapy was pre-treatment elevation of ALT.