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Your liver function tests are abnormal or worsening , or you have been told you are at high risk of liver fibrosis (for example, a high FIB-4 score or ELF score 10.51)

However, the latest data from the CIRT, with its negative results, imply that the inflammatory pathway is rather complex and that the adenosine-mediated anti-inflammatory effect of methotrexate might not be as effective as canakinumab at targeting IL-1

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Thus, CARN depletion may impair active tubular secretion of MTX, leading to decreased clearance and higher serum levels

Strycharz-Dudziak, M., Kieczykowska, M., Drop, B., et al