How do you assess transaminitis in a patient with sarcoidosis with known liver involvement being treated with methotrexate?

This can be fairly tough, as you cannot assess for hepatoxicity from methotrexate in a patient who already has a transaminitis. Hepatic sarcoidosis occurs in 11-80% cases and is often asymptomatic. Some patients may have a transaminitis, elevated alk phos, or liver lesions noted on imaging. Serious liver disease, such as cirrhosis, can occur but is rare. There are no controlled studies on the treatment of hepatic sarcoid, so most recommendations are based on clinical experience and retrospective...