Decision Report 201304126

Summary

Mrs C complained on behalf of her husband (Mr C) who had suffered from rheumatoid arthritis for many years. In 1996 he began taking a low dose of methotrexate (MTX - a disease modifying drug.) In 2003, Mr C had a biopsy (tissue sample) taken, which showed fatty changes to his liver. Mrs C felt that at this stage the MTX should have been stopped. However, Mr C went on to take the drug for a further two years before he was told to stop it. The board said this was because the benefits of a low dose of MTX in terms of treating Mr C's rheumatoid arthritis outweighed any potential detrimental effects on his liver. Mr C was later diagnosed with cirrhosis of the liver (scarring of the liver as a result of continuous, long-term damage). Mrs C complained that this was because of the MTX.

To investigate the complaint, we took all the relevant information, including the complaints correspondence and Mr C's clinical records, into account. We also obtained independent advice from one of our medical advisers. Our adviser said that in 2003 it was reasonable for Mr C to continue with MTX as the risks associated with it, although serious, were rare and the decision was taken in the full knowledge of all the factors involved. The adviser also said that at the same time Mr C was strongly advised about weight reduction, glucose control and close monitoring of his blood pressure. In 2005, Mr C's liver function tests showed a mild disturbance and, taking into account the existing fatty liver disease, his increasing weight and diabetes, it was decided then to stop the MTX. While Mr C had taken a low dose of MTX for a number of years, our adviser confirmed that it was not the length of time for which someone was exposed to the drug but rather the overall exposure that was likely to increase the risk. In light of this, we did not uphold the complaint.