case with past HCV infection& Liver fibrosis F4 fibroscan normal LFTs & now diagnosed as having RA,does F4 absolutely contraindicates use of MTX &/or leflunamide?
MTX is well known to cause liver fibrosis so may exacerbate the existing condition even without deranging LFT. It is better avoided. Leflunomide has serious adverse effects on liver so needs to be avoided. But certain information needs to be known like age of patient, type of RA, HCV RNA level, P.Time,
60 years old, seronegative erosive Rheumatoid arthritis without extra-articular manifesations PCR for HCV is non detected after treatment and all liver function tests and coagulation profile are within normal ranges
To eradicate the HCV infection is the main goal to achieve in all the cases
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