Anti smooth muscle antibodies & arthalgia (13/1700)

A 29yo lady who is a bank manager is referred by the GP to the medical OPC due to
a long hx of tiredness and pain in the joints. An autoimmune screen result showed
smooth muscle antibodies positive. What is the most appropriate next inv?

a. ECG
b. TFT
c. LFT
d. Serum glucose
e. Jejunal biopsy
















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answerC....autoimmune hepaptis
• diagnosis of exclusion: rule out viruses, drugs, metabolic, or genetic causes
• can be severe: 40% mortality at 6 mo without treatment
• extrahepatic manifestations
ƒ sicca, Raynaud’s, thyroiditis, Sjögren’s, arthralgias
ƒ hypergammaglobulinemia
Š anti-smooth muscle antibody elevation is most characteristic; also elevations in
Š anti-LKM (liver kidney microsome, especially in children)
– less specific: elevated ANA, RF
Š can have false positive viral serology (especially anti-HCV)
Š biopsy – periportal (zone 1) and interface inflammation and necrosis

ttt: steriods/azathioprine