Can it be AIH with no elevated liver enzymes or SED rate?

[Zizle]

I've had high ANA and ASMA/Actin Antibody titers, and + rheumatoid factor since 2005, when I developed an itchy post-partum rash over 60% of my body. It looked like goosebumps on sunburn and nothing provided relief. It disappeared after weaning at one year. The cause was determined to be autoimmune after skin biopsies and steroid creams failed, and autoantibodies were tested for.  I never followed up after the rash cleared, went on to have a normal pregnancy 2 years later, and I'm now 2 years post-partum (still nursing but <2/day).  I shared my old test results with a new doctor to help evaluate 3 months of chronic diarrhea and digestive upset (I have a 10-yr history of mild IBS-D and lactose intolerance), but this is different. Most foods are a trigger now.

Well the same antibodies were positive again, with a doubling of the ANA (1:1280/speckled) and actin antibody (57), and rheumatoid factor (27). All other antibodies were negative, SED rate was normal, liver and kidney chemistries normal, C-reactive protein normal, no anemia, CBC normal, etc. I do have a history of mononucleosis as a teen, pale stool following a GI infection in Central America 10 years ago (perhaps Hep A), and several uses of Macrobid antibiotic for UTIs (another document trigger of AIH). I also received the Hepatitis B vaccine during my early 20's as a healthcare worker.

I am seeing a gastroenterologist Friday and a rheumatologist in 2 weeks at the request of my new internist.  Although the antobodies point to AIH, could my liver be disease-free despite the antibodies?? If I had these 5 years ago, wouldn't they have produced noticeable disease by now (besides the mild chronic diarrhea and mild fatigue?)

What tests should I expect? Ultrasound? MRI? Colonoscopy? More blood tests? If liver enzymes remain normal, there is no need to treat, correct?  Are there dietary interventions and alternative medicine herbs or vitamins that can help prevent a flare of AIH?  

I feel like a ticking time-bomb! Is there hope??

[Zizle]

Well it turns out I have microscopic colitis, and this should explain the antibodies.  The rheumy wants me to have liver and kidney chemistries checked every 6 months to catch any new disease progression (such as AIH) early.

[Debbie22]

Well, the diagnosis can be very tricky. I am not a doctor but based on your description I would say that it looks like you don't have AIH... below is a guide that I used a lot while researching trying to understand how the doctor's can tell for sure... and my experience is that this guide helped me a lot! At least I was able to ask pointed questions, ask for lab works that were guided to help on my diagnosis. In my case I was able to put together my score very easily and when I didn't have a info about a especific blood work, I asked my doctor's to order... in the end my diagnosis was confirmed. At least it gave me benchmarks, what to look and expect for... I hope it helps! I wish you all the best!

ok... I tried to copy here but it didn't work well... here is the link.. it is an excelent resource... :D

http://www.arupconsult.com/Topics/AIH.html#

Diagnosis

•Indications for testing – persistently elevated alanine aminotransferase (ALT), aspartate aminotransferase (AST) (5x normal) in the absence of any other cause of liver disease or damage
•Diagnostic criteria
◦There is no single diagnostic test for AIH; diagnosis of exclusion
◦Serum IgG >2.5 g/dL
◦Autoantibodies may include
•Antinuclear antibodies (ANA)
•Smooth muscle antibody (SMA)
•Liver/kidney microsome type 1 (LKM-1) antibody
•Antimitochondrial antibody (AMA)
•Soluble liver antigen (SLA) antibody
◦Autoantibodies may not be present in about 10-30% of patients with clinical features of AIH
◦Histology to determine or evaluate liver damage

•Laboratory Testing
◦Liver function tests – usually elevated
◦Gammaglobulins (IgA, IgG) – elevated
◦Nonspecific antibodies – positive ANA homogenous pattern, rheumatoid factor
◦Specific antibodies
•LKM-1 antibodies
◦React uniformly with cytochrome P450 2D6, a 50kDA protein found in the cytoplasm of all hepatocytes and renal proximal tubular cells
◦In the U.S., LKM-1 antibodies are common in pediatric patients and rare in adults
◦LKM-1 antibodies occur in only 4% of adults with AIH
•Smooth muscle antibodies (F-actin)
◦SMA antibodies are the hallmark of AIH type 1
◦Also seen in chronic hepatitis
◦Testing LKM positive patients for ANA and SMA may be helpful in distinguishing between type 1 and type 2 AIH
•Soluble liver antigen (SLA)
◦The presence of SLA antibodies has almost 100% specificity for autoimmune

[Jody515]

Sorry I can't answer your questions. My enzymes were quite high when I was diagnosed with AIH. But does that mean everyone's is? I don't know but wish you best of luck & hope all goes well at the doctors.  Let us know.
Jody