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Re: Significance of high anti-smooth-muscle test?

Posted By HFHSM.D.-D.M. on February 07, 1999 at 15:56:07:

In Reply to: Significance of high anti-smooth-muscle test? posted by GB on January 29, 1999 at 18:35:19:

First of all, thank you to the doctors who offer their time and expertise to answer questions this way.
I am 44, female caucasian nonsmoker, generally good health. Troubled for years by small patches of numbness and pain on hands & feet, minor joint pains, tendinitis, etc. Thought the numbness in hands was just a typing injury till it showed up in my feet also. Ouch!
Dr. suspects autoimmune disorder is causing my nerves to get inflamed and die off. Nerve conduction tests on large nerves are OK, so evidently this is not a neuropathy.
Dr. ordered antibody tests to rule out Lupus which came back negative except for a "very high" (positive 492) anti smooth muscle antibody.
Is there any significance to this lab result? Info on the Internet is confusing on this subject. Is this just an "artifact" in an otherwise healthy person, or an indication of liver disease or something else?
I am also a regular blood donor. Never had hepatitis or otherwise failed the blood bank's donor screening.
Should I worry about this or not?


Dear GB:
I appreciate your interesting and somewhat unusual questions.  You recently tested high for a positive ASMA titer and you want to know what this means.  Youve been getting confusing answers from other Internet sites.  Well, I cant promise I will lift the confusion but Ill see what I can do.
However, the first question I have for you is whether your liver enzymes are elevated. The anti-smooth muscle antibody (ASMA) can be a sign of something called autoimmune hepatitis.  This is a condition in which the bodies own immune system attacks the liver.  If someone has elevated liver enzymes (blood tests) and there is no other obvious cause for liver disease and either the ANA or the ASMA is elevated, they may well have autoimmune hepatitis though sometimes we will do a liver biopsy to try to pin this down.  However, in someone with normal liver enzymes, the significance of a positive ASMA is less clear because we usually wouldnt get an ASMA in this setting.  However, most patients with autoimmune hepatitis have elevated liver enzymes and the presence of normal liver enzymes would argue against the diagnosis.  You might want to repeat the ASMA  just to be sure and repeat the liver enzymes as well.  
I hope this information is helpful to you. If you have additional questions or more information, feel free to post the material back to MEDHELP or you are always welcome to contact us directly at Henry Ford at (313) 916-8865.  If you are in the Detroit area, I would invite you to visit us.  We have an active group of liver specialists.
This response is being provided for general informational purposes only and should not be considered medical advice or consultation.  Always check with your personal physician when you have a question pertaining to your health.  

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