Raised bilirubin and GGT

[komtin]

Hi there,

I'd really appreciate some advice regarding the following issue. I am a 29 year-old woman. Several months ago some joints on my fingers were swollen and red but not painful. This lasted for a few weeks and then went away. I did not pay attention as I thought it was over. However, about a month later the same joints started swelling again and this time they became painful and stiff, especially in the morning and throughout the day.

I visited my GP and had some blood tests for several conditions. Rheumatoid arthritis, gout and other similar conditions were ruled out as the factors were not present, and no sign of infection. My GP prescribed some further tests - liver function tests, which showed an elevated bilirubin level and also elevated Gamma GT. After a couple of months the same tests showed slightly higher levels of bilirubin and Gamma GT than the previous test.
Other tests showed slightly raised anti-nuclear antibodies, however the doctor advised me that this does not necessarily mean I have an auto-immune disease. Since my fingers were fine at the time of the tests, there was no clinical examination.
I had an abdomen ultrasound which was normal, did not reveal any problems whatsoever with my liver, splene or other organs. I have also noticed my right leg (calf) is often stiff and painful and feels swollen during the day.

This is a bit confusing and not sure what to make of it. Do you have any clue as to what this might be?

Thank you,
KT

[Dr. Kokil Mathur]

No, EBV can cause recurrent infection from time to time

[komtin]

Thank you for taking the time to respond to my question. I will certainly discuss further with my GP and hopefully further testing will give more insight.
Is Epstein-Barr a recurrent condition? I was very ill a few years back with infectious mononucleosis and had an enlarged spleen, it also caused other secondary infections (acute peritonsilitis) and I was hospitalized. I have not mentioned this to my GP as I thought it irrelevant. My impression is that the EBV virus only attacks once and then usually does not cause problems again. Is this the case, or should I look into the EBV issue further?
Again thank you, your response is much appreciated.

[Dr. Kokil Mathur]

Hi!
High GGT levels are seen in liver diseases such as hepatitis, cirrhosis, liver tumors, and jaundice. Other causes of high GGT include heavy or chronic alcohol use (ruled out in your case), myocardial infarction, pancreatic cancer or pancreatitis and viral infections such as Reye's Syndrome, Epstein-Barr, or cytomegalovirus (CMV). A high bilirubin can indicate hepatitis, liver and pancreatic cancer, cirrhosis, gall stones, and biliary stricture. It can even be due to hemolytic anemia. So these causes should be looked into, and an ultrasound may not be enough to diagnose these. Also, if the levels are marginally high then, they may revert to normal. However, if they keep increasing, it is necessary to investigate them properly.
Generally a high ANA titre indicates an autoimmune disease (SLE, Sjögren's syndrome, rheumatoid arthritis, autoimmune hepatitis, scleroderma, polymyositis, autoimmune hemolytic anemia, dermatomyositis). Now, since you have joint and bone involvement on and off, it shouldbe further investigated with ANA staining. Depending on the pattern of ANA staining, other antibody tests will have to be done.  Please discuss with your doctor. Take care!
I sincerely hope you will find this information useful in your journey towards better health.
Hope you get well soon! Good Luck and take care!

[komtin]

I should also add that I don't drink alcohol, I have a generally healthy diet and i am not overweight or have any other health conditions that I know of.
Thanks