How would you approach treating a patient with Rheumatoid arthritis/Psoriatic arthritis and alcoholic cirrhosis?

The liver plays a central role in the clearance of nearly all small molecule (e.g. non-biologic) drugs. Thus, cirrhosis perturbs the clearance of these agents. Moreover, there generally is a potential deleterious effect on hepatocyte health, making these drugs unattractive from a safety perspective. Ergo, their use is not recommended in cirrhosis.

Biologics (rituximab, abatacept, TNF antagonists) have generally have not been shown to effect liver injury. These would be my primary choices in RA a...