PSC, AIH, and/or Fatty Liver...thoughts?

I'm normally on the ulcerative colitis forum but hoping to get some clarity here about liver issues.

My liver function tests were completely normal until April 3 of this year, when my ALT showed 10 points above normal (AST was still normal). At this time I was finishing a 2.5 month course of prednisone and had tried a couple of other UC meds that didn't work. We did this liver test the day I started Remicade, before the medication was administered.

They do LFTs with every Remicade infusion. With one exception, when the tests completely normalized in mid-May, the LFTs have gone up slightly every month.

In September, they did an autoimmune workup and found:

ANA positive at 1:80 with anti-actin antibodies
ASMA positive at 1:80
SPEP, immunoglobulins, iron, AMAs, cerruloplasmin, alpha-1 antitrypsin, celiac panel all normal/negative

My AST and ALT were 51 and 60 last week, which is another slight increase; all other numbers normal though alkaline phosphatase is 106 - that has been increasing slightly, too (though still normal).

I had a liver biopsy on Friday. No results yet but I am freaking out waiting to hear something. I lost my Dad to liver failure when his Hep C recurred in his transplanted liver 13 years ago, so anything liver-related terrifies me.

My cholesterol tends to be on the high side (though not high enough for medication). I am underweight thanks to my year of ulcerative colitis, which is now pretty much in remission thanks to Remicade. And about 15 years ago I was told that I *might* have "slight" fatty liver disease following a biopsy for crazy-high LFTs, but that's all and tests have been normal since then.

So....drug-induced autoimmune hepatitis? AIH? PSC? Fatty liver? Thoughts? Even just a "hey, chill out, whatever it is you can handle it" would help. Thanks.

hi fletch 10, welcome aboard the hep forum.

I agree with ppm guy, after biopsy, check with the hep docs.

I will send our AIH moderator a note so she knows to keep an eye out for your posts. She notes that with the proper med regimen, she manages her AIH with pretty much NO symptoms over the long haul. Few flares and a normal life...had a family, etc.

Best,
Mama Lama

Hi Fletch!

So my AIH came after having the family and getting divorced but I have remained flare free since diagnosis almost 11yrs ago (Jan 18, 2007 to be exact). I’ve survived one lay off and am in another. Just got notice 6days ago. Yay! Ugh haha!
That was my rollercoaster right there!
ANA at 1:80 is super low on positivity. Most docs wouldn’t worry about that number. However, you’re on treatments which could mask things. I also wouldn’t worry about the levels of your LFTs. Some people after being ill have ‘new normals’, so that might be yours. Even with AIH flares they generally only get concerned when they are over 100.
Try not to stress out, easier said than done, as stress wreaks havoc on autoimmune conditions. When are your results expected? They will tell you what you need to know and let’s hope it’s nothing or just a blip from the UC!

Yay! Let’s hope the PSC is fine too

Ocamo,

I’m not sure why you or your doctor would think you have AIH based on your ANA or LFTs...all your numbers are normal. Work on getting your cholesterol under 200 and if you need to lose weight, try to lose weight. It certainly doesn’t sound like AIH. Stay away from alcohol if you want to be more kind to your liver since you have fatty liver.

Happy holidays!