Ama meaning?

[luisv187]

I was just wondering since i see people posting that positive ama doesn't confirm you have pbc, than what else can positive ama mean?

[Hidden]

Hello luisv187.

Well back in early 2010 when I started itching and took myself off to see my GP who then took bloods - the liver function test (LFTs) - it was found they were abnormal. From there he deduced it was a liver-related problem as opposed to a bone-related one (you can have abnormal LFTs with a bone problem) and I continued with various bloods to rule out certain things until I ended up seeing a hospital consultant at out-patients 8 months later.

I had the antibodies bloods done on my first consultation and from this I was diagnosed with PBC due to having what the consultant wrote on the letter I have 'a high titre of AMAs'. I had symptons that correlate with PBC - itching and at the time fatigue, abnormal LFTs along with another blood abnormality that is taken with a liver problem, the GGT and I had the AMAs.

Usually if there is any doubt a liver biopsy is performed for diagnosis of PBC.

It seems that the AMAs can fluctuate as I have noticed that some on this site have mentioned having the AMA blood test done at a later date. For myself I have only had the one AMA check which was for diagnosis. I know at the time I also had the ANA blood check that turned up negative, so did certain other ones apparently.

Though I cannot say for sure, my theory is that sometimes our AMAs in this case for PBC might be at a low or non-existent and I think at these times the PBC has slowed down even more or even come to a halt 'temporarily' (I say this loosely as there would probably be no way of knowing if it was to ever start up again).

The only thing I can actually think of where some say they positive AMAs doesn't confirm their PBC is that it isn't a specific rating that counts. Though no-one has ever said, is it possible that some can have the AMAs present in a small measure but it never leading to anything. There are certain things we can have that never manifest into anything else that we can have.

I'm now only interested in finding out how it actually started that I came to have PBC and also how it could possibly be halted.

I have also found through this site that it varies country to country how PBC is dealt with. In the US for eg if you are diagnosed with PBC you still have to have a liver biopsy for what it known as staging. This is something I'd nto agree to if I was diagnosed without the need. I am not interested in this so-called staging myself. I am confident with new technology now this biopsy isn't required for one diagnosed with PBC by the 3 factors that I had.

[badpiglet]

Different forms of AMA can crop up in several different conditions. Worth remembering - to avoid unnecessary stress & worry - that doctors do not normally diagnose any condition from a positive AMA result alone.

Someone reading this may have more knowledge - if so please correct me - but I think some of the other conditions where different types of AMA are found are: autoimmune hepatitis, syphilis, cardiomyopathy, systemic lupus erythematosus, sjögren’s syndrome, systemic sclerosis, asymptomatic recurrent bacteriuria in women, pulmonary tuberculosis, leprosy.

If I've got this wrong anyone, please jump in.

As correct information can change very quickly in the medical world, I'd ask your doctors Luisv187, to see what they say - they're the best people to ask as the internet has too much out of date, inaccurate stuff on it.

[Kevin733]

AMA alone, in any measure, certainly doesn't confirm a PBC diagnosis. First, there are many different types of positive AMA. The one most associated with PBC is anti-M2. When AMA is associated with a disease, it's most commonly associated with PBC, but less commonly it's associated with auto-immune hepatitis. There is also an overlap syndrome between the two.

However, there's a segment of the population (at least 0.5%, or 1 in 200) that has AMA naturally, without a link to any disease. For perspective, the highest estimated prevalence of PBC published is 1 in 3000, and the PBC gender ratio is at least 9:1 female:male. However, the AMA gender ratio is roughly 1:1.

From this it follows that, at most, 6.7% (200/3000) of the AMA-positive population actually has PBC.

To put it another way, suppose that AMA alone were sufficient to diagnose PBC in women. Now suppose that you have 18 people (9 women and 9 men), all AMA positive. Based on the gender ratios above, all of the women would have PBC, but only 1 of the men would. Even in this extreme example, the percentage of AMA-positive people with PBC would be only 56% (10/18).

It's AMA in the presence in persistently elevated liver enzymes (particularly ALP) that's suggestive of PBC. It's important not to interpret AMA statistics in a vacuum.

[teddybear7]

I have been diagnosed without a biopsy. High titre ama's. But I have lots of other symptoms. & ana's so it was taking everything in to account not necessary for a biopsy.

[rbwphd]

A (+) M2 AMA really means nothing without an increase in alkaline phosphatase (AP). I had a (+) AMA of 60+ back in 2012 that was confirmed by a second test a month later. This was after I was experiencing the same epigastric pain a few years after I had a cholecystectomy and it turned out to be mucosal stomach ulcers. I get my liver enzymes checked yearly at routine checkups. There is the slight possibility that one would go on to develop PBC with these labs but my understanding is that it would be a very mild form of the disease. In this case I am not having a biopsy done unless the AP starts to rise above normal. I am trained as a physician (I am not a GI doc) and another issue is that when labs are done, the physician feels compelled to "treat the labs" when no actual disease exists. I would have my AP/transaminases checked in another 3-6 months and go from there.

[luisv187]

So theres no other desease that will make you have positive ama m2?

[badpiglet]

From what I've read, but I'm not 100% sure - so please do get someone who's medically trained to confirm - AMA M2 may be found in the following conditions:

acute liver failure

pseudosyphilis

autoimmune hepatitis (AIH)

and AIH/PBC crossover.

rbwphd, who posted above, or your own doctors, may be able to confirm, correct or add to this.

Repeating what others have said:

Diagnosis of a condition will only happen when doctors look at the whole picture (not just AMA M2 results) including all other test results, medical history, any symptoms, family medical history and environmental/lifestyle factors where relevant.

In some instances, positive AMA M2 results will not lead to any diagnosis at all if the person has no symptoms, is physically healthy and all other tests are normal and remain normal when tests are repeated over time.

[Kevin733]

Luis, following up on your last question, there are other diseases associated with AMA M2. Bad Piglet lists several above. The most common of them (besides PBC) is AIH or PBC/AIH overlap. However, 0.5% of the healthy population also has AMA, so it might not be a marker for disease at all. That's why it's so important not to interpret the result in a vaccum and to look at liver enzyme and IGM levels, for instance.