I'm 49, female and my gastroengerologist has quickly made the PBC diagnosis based on positive AMA (84.4 units , pos = >24.9), elevated AST (44, scale of 0-40), ALT (38, scale of 0-32), and high IGM 730 (scale of 40-230). My ALB and BIL are within acceptable range and three separate tests have also shown normal ALP levels (latest was 89, scale of 42-155). SED rate = 66. Recent bloodwork has also shown increased rheumatoid factor. The reason I'm asking is because my Rheumatologist disagrees, and says without the elevated ALP, we could be looking at a different disease. I'm new to this and have read several articles which point to PBC given elevated AMA and liver enzyme tests, and that IGM may be used to help confirm the suspicion of PBC. An ultrasound last month showed a normal pancreas, left kidney and liver. As per symptoms, I was highly fatigued but my energy level is much better now that I have been gluten free for two months and have dropped 15 lbs. My hands are severly swollen, palms are red and the skin has become tight and dry. (My dermatologist says it is hand dermatitis.) I have no itching, but do have dry eyes, am thirsty and have Raynauds. Although I'm not totally on board with it, have been scheduled for a CT guided liver biopsy in 10 days because the Gastro beleives this should be staged.