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Dr. Thomas, MD
Dr. Thomas, MD, Board Certified Physician
Category: Medical
Satisfied Customers: 63757
Experience:  Internal Medicine--practice all of internal medicine, all ages, family, also Integrative, CAM, etc
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I have had off and on elevations of AST and ALT

Customer Question

Hi. I have had off and on elevations of AST and ALT for about 5 years. I did an ultrasound then and showed some fat. Since my last blood work in October, both have risen and are now AST 65 and ALT 51.
* No alcohol at all
* Weight 125
* I have mild RA, Grave's (in remission) and anxiety
* Meds: Sulfasalizine, Lexipro
* Good cholesterol, no Diabetes, normal ANA, no HEP
I'm not sure what to think. :(
Submitted: 6 months ago.
Category: Medical
Expert:  Dr. Thomas, MD replied 6 months ago.
HelloYou need to be tested for hep B and hep CAlso you need iron studies to rule out hemachromatosisAnd an ANA to rule out autoimmune hepatitis.If these are all normal, then it is fatty liver.WEight if you are over weight loss and diet are then indicated. OK, so you might have more questions or want to give me more information: Please use reply to expert if you have further questions. When you are ready, please click a positive rating [hopefully excellent—that’s how we are paid, per rating]. If you forgot something, come back. I am here daily.
Expert:  Nadim Al-Mubarak replied 6 months ago.
I have a different answer for you These are mild elevation in the AST/ALT and not unusual with Sulfasalizine. Fatty liver is unlikely given that you are not alcoholic and not overweight. This is very unlikely to be serious. Ultra Sound is not very sensitive establishing fatty liver, which is generally not a serious condition. Basic hepatitis profile is standard though these are unlikely to be the issue. Your ANA is going to be positive since you have RA, and in and by itself is not enough to establish autoimmune hepatitis. I would recommend that you discuss it with your Rheumatologist and if you are still concerned, you may see a Hepatologist, a liver specialist. There is a large host of liver tests and imaging to be recommended, but we are not a in position to recommend what tests you should get, as we do not order them. The doctors who know you best and are very familiar with your condition are in the best position to do so. Best of luck If you have any further questions, please let me now. If you are satisfied with my answer, please complete the stars rating .
Expert:  Dr. Thomas, MD replied 6 months ago.
HelloAs you have stated, you have fatty liver.Non alcohol fatty liver disease can be serious and by definition you don't drink and you do not have to be overweight.Anti smooth muscle antibody is a test that further tests for autoimmune hepatitis.The degree of elevation of your enzymes , when constant, does not correlated with the degree of liver involvement from any entity.See my premium services offer.Find me, Dr. thomas [double board certified US doctor], any day of the week for correct, safe and comprehensive answers.Your regular doctor can order these test [including iron studies which must be done, as you are in the age range for iron storage disease], prior to any referral.