I HAVE A POSITIVE AMA AND ANA,LFTS ARE NORM... - PBC Foundation
I HAVE A POSITIVE AMA AND ANA,LFTS ARE NORMAL BILE DUCTS ARE DILATED 7MM. DO I HAVE PBC OR CAN THIS BE ANOTHER DISEASE?
Hello Robinlori.
Having various antibodies usually determine certain things. As in case of the AMAs PBC is usually diagosed. (I was diagnosed with PBC Dec 2010 due to itching and fatigue earlier in 2010 and then having abnormal LFTs and then was found I had a high titre of AMAs. I am in UK and biopsy isn't usually considered if a doctor can make diagnosis without the need.)
I presume you had some test due to stating you have a certain mm of dilated bile ducts. I don't really understand that as I've never had a biopsy and no more than an ultrasound scan that apparently showed my bile ducts were clear at the time, my liver and surrounding organs looks normal.
I think sometimes it is best not to speculate. I am not fully certain of what having both of the antibodies mean, whether it means that there are 2 auto-immune conditions or just one.
If your LFTs are normal as you state and I will hazard a guess that the bile ducts appear to seem quite normal given the word 'dilated' you used.. If this is so then I expect for now you'd be monitored for any future changes.
THANK YOU SO MUCH FOR YOUR REPLY, PERIDOT. I HAD A SPECIALIZED MRI CALLED AN MRCP. I AM EXTREMELY FATIGUED, ITCHY AND HAVE HORRIBLE RIGHT UPPER QUAD PAIN. THEY TELL ME IT'S CROHNS DISEASE BUT I DON'T HAVE ANY OF THE CLASSIC SYMPTOMS OF CROHNS BUT ALL THE SYMPTOMS OF PBC. IN FACT THE 2 DRS THERE ARGUED ABOUT THIS BECAUSE ONE SAID IT'S PBC AND THE OTHER SAID CROHNS. THE ONE WHO SAID CROHNS SAID I CAN'T HAVE PBC BECAUSE EXCEPT FOR THE ALK PHOS THE LFTS WERE NORMAL. I HAVE READ THAT YOU CAN STILL HAVE IT EVEN THOUGH NORMAL LFTS. MY MITOCHONDRIAL ANTIBODY WAS DOUBLE.
Hello again Robinlori.
You can have PBC, have positive AMAs as I had when tested 2010 but still have normal LFTs. You will find others on this site who might add a response who do actually have normal LFTs but have PBC.
I would more than likely have started out with normal LFTs though I have no way of knowing, over time they started to become abnormal due to the process of PBC. You appear to have some classic symptons of PBC, some with PBC can be asymptomatic, that is no symptons yet have AMAs, others can have both.
LFTs can fluctuate. Mine were abnormal and continuing to rise slowly during 2010. My last ones taken by my GP August 2010 showed to be at their highest out of all my readings but in that period between August and then November when I had another LFT done and also one for AMAs (and ANAs - this one was negative), I noticed on getting the print-outs of the bloods done on a few occasions pre-diagnosis and the day I had the AMA, my LFTs had actually decreased naturally as I wasn't on urso until Dec 2010.
I believe with early PBC we sort of stutter and stop and start. Thinking back about 6mths prior to starting with the itch I went through a couple weeks where I felt itchy but never thought a thing about it. It then vanished.
AMA is defintely a marker for PBC but even this AMA (anti-mitochondrial antibody) can show up at a future date as negative. My theory there is that PBC can stop and start. For some returning to normal LFTs usually with taking urso in PBC it has gone into a sort of suspended mode where it isn't progressing at the time. Of course there is no guarantee it won't start up again at some time in the future.
You noted that you had the MRCP, well did you have a liver biopsy done at the time as MRCP can attain one. If so that would definitely give a diagnosis of PBC due to liver cell changes.
Hello again Robinlori.
Apparently the abnormal Alk Phos (ALP) shows that there is bile duct damage. Mine have been abnormal since I was first tested with regards to the LFTs back in early 2010. I still have abnormal LFTs but they are much much better than they were back in 2010.
NO, I DIDN'T HAVE A LIVER BIOPSY BECAUSE ONE OF THE DRS INSISTS BECAUSE OF NORMAL LFTS THAT THERE IS NO NEED. AFTER READING ALOT OF COMMENTS ON THE INTERNET I BELIEVE HE'S WRONG ALTHOUGH HE DOES HAVE A SELF GOD LIKE ATTITUDE WHEREAS IT'S IMPOSSIBLE FOR HIM TO BE WRONG. I DEFINITELY NEED TO SEE SOMEONE ELSE. THX SO MUCH FOR ALL YOUR GREAT REPLIES. I REALLY APPRECIATE THEM.
Hi Robinlori.
Just to clarify the post above regarding MRCP - it is incorrect to state a liver biopsy can be taken during MRCP. As you would know having had one, MRCP is a specialized MRI scan for viewing in particular the bile ducts,pancreatic duct and gallbladder. It is non invasive and involves lying in a MRI scanner while magnetic resonance imaging produces detailed pictures. The procedure ERCP -endoscopic retrograde cholangiopancreatography - on the other hand IS invasive and involves a flexible scope that is inserted through the mouth and examines liver, gallbladder and pancreatic ducts. It is during this procedure that it is possible to obtain a liver biopsy. I believe most liver biopsies for PBC , however, are taken using the standard technique of ultrasound guided biopsy. I have had 2 biopsies taken this way and as long as a reasonable sample is taken it remains a useful tool.
I hope this makes sense - I strongly believe that we are here to help each other on a forum such as this but at the same time I guess we need to be really careful that we endeavour to give accurate information. I have been a nurse for 30 years and I am still reluctant to give patients/relatives medical information without being 100% sure that I have all the facts at hand.
It sounds as though you need to see a new specialist you have faith in and I wish you all the very best on your PBC journey.
Karaliz
Hi there, what to do if you are only ama-m2 positive but have normal liver function test ?
