Alt high 60, ast high 45 on methotrexate 25mg, arava (leflunomide) 20mg, enbrel weekly. should i be concerned? never had pblm.

Maybe: I, personally am not a big fan of using Methotrexate and Arava (leflunomide) in combination because of the increased risk of liver toxicity. Your enzymes are only mildly elevated but i would talk to your rheumatologist about reducing dosages or eliminating one of the meds altogether.

Talk to your doctor: Those are not terribly high lab values for alt and ast. Such modestly elevated labs that measure liver irritation (or damage/disease when > 2-3 times the upper limit of normal) can be temporarily caused by common viral infections, alcohol consumption, or interactions with other meds that affect the liver. Getting labs checked within 48hrs of Methotrexate can also result in higher lab values.