ANA Positive

[Guest guest]

My husband went to the doc on Wednesday. All his tests came back fine, ALT

and AST were within the normal ranges. The ANA came back positive though, so

the doc wants to do a liver biopsy.

He hasn't taken any med so the ALT and AST have come down on their own. Even

at their highest (which caused the jaundice and his trip to the hospital),

they were never over 400. The doc said that the ANA test alone doesn't mean

anything, but he wants to check the liver for inflammatory cells and see if

there is any damage. He did have ulcerative colitis and had his colon

removed in 1991 (he is 31 now).

They have done an ultrasound which showed a fatty liver, but the doctor

didn't seem too concerned about that and doesn't think he will find any

significant liver damage when he does the biopsy.

Does anyone have any thoughts about this? Is it normal for the levels to

return to normal in a week with autoimmune hep?

I have been reading a lot of posts were people are talking about liver

transplants. Are they common with people who have autoimmune hep or does it

depend on how long it went undetected. I don't want to be nosy, I'm just

looking for answers and other's opinions.

Thanks.

Jackie

[Guest guest]

Jackie,

Though it's tempting, I'd be reluctant to 2nd. guess my doctor. It sounds

like your husband's doctor is concerned and thorough. Your husband is

lucky, considering the fact that too many of us have had doctors who see

potential problems and don't take that extra step to eliminate possibilities.

You bring up some questions I've also had. That is, can there be

spontaneous remission from AIH? My Hepatologist hinted to me that this is

possible and in fact, happens about 1/3 of the time. Since I've gone from

stage IV (range of I to IV) cirrhosis and grade 3-4 inflammation to nearly

total remission in less than 2 years, it's clear remissions can happen. My

own biggest problems are the results of Prednisone and Imuran and I

consider them to be a small price to pay for " life " . But I can't resist

that nagging question about whether remission would have happened anyhow,

once the inflammation was under control.

My levels dropped to normal fairly quickly. I don't know how quickly, but

within a few weeks. Those that normalized have never elevated again in

more than a year. The only consistent high is GGTP. This basically

confirms that there is liver damage which essentially (to me) means that I

don't have a lot of leeway for another severe episode. However, my doctors

think that's highly unlikely as long as I remain on comparatively low doses

of Prednisone and Imuran. I've observed that several others in this group

have had the same experiences.

Everyone's condition is different, but at least in my own case, it was

thought that I would need a transplant because of the degree of cirrhosis

and inflammation. I was evaluated, in fact, for transplant. However, when

remission is achieved or when the condition can be brought under control, a

transplant is no longer necessary. The prognosis is entirely unpredictable

and I doubt that a responsible doctor would say that anything is certain.

Speaking for myself, I no longer see a transplant in my future. Everything

could change overnight or never. I'm going for " never " !

My personal advice to your husband would be to let the doctor do whatever

diagnostic tests he feels are indicated until he is satisfied he's

identified the degree of his AIH, then follow the doctor's advice about

medication and lifestyle and assume that remission will happen. But, do

this conditionally. Continue to research AIH and liver disease in general,

compare your husband's progress with those of others, compare his medical

treatment with the treatment others are getting from top Hepatologists,

and if you at any time feel uncomfortable or if you question what is being

done, see another specialist for a second opinion. Above all, I repeat the

advice that Barbara and Joanne and others have given over and over. Your

husband should either be in the care of a Hepatologist with experience

treating AIH patients, or he should have a consultation with a Hepatologist

from a major transplant or liver disease center. Probably both.

Take care,

Geri