Hi! Thanks for choosing HCM for your query. I have gone through the problem described in your question. I am of the opinion that the high laboratory parameters are suggestive of liver injury most probably caused by Methotrexate. Methotrexate and Arava are known to cause liver injury which is reflected in the form of elevated AST and ALT. The RDW and MCV levels can both be increased if there is too less vitamin folic acid. Methotrexate acts by inhibiting the folic acid metabolism thereby causing folic acid deficiency which is reflected in the form of high RDW and MCV levels. You are advised to consult your rheumatologist for review and possible use of alternate drugs like Hydroxychloroquine, of Infliximab. Hope your query has been answered. Give a positive feedback if convinced with the above explanation.