How JustAnswer Works:
  • Ask an Expert
    Experts are full of valuable knowledge and are ready to help with any question. Credentials confirmed by a Fortune 500 verification firm.
  • Get a Professional Answer
    Via email, text message, or notification as you wait on our site.
    Ask follow up questions if you need to.
  • 100% Satisfaction Guarantee
    Rate the answer you receive.
Ask DrRussMD Your Own Question
DrRussMD, Board Certified Physician
Category: Medical
Satisfied Customers: 64947
Experience:  Internal Medicine--practice all of internal medicine, all ages, family, health, prevention, complementary medicine, etc.
Type Your Medical Question Here...
DrRussMD is online now
A new question is answered every 9 seconds

I have had off and on elevations of AST and ALT for about 5

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: 1 year ago.
Category: Medical
Expert:  DrRussMD replied 1 year ago.


You need to be tested for hep B and hep C

Also you need iron studies to rule out hemachromatosis

And 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 1 year 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:  DrRussMD replied 1 year ago.


As 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.