What is your approach to a patient with normal LFTS and high titer auto-antibodies suggestive of autoimmune hepatitis?

Normal LFTs in the setting of high titer liver autoantibodies would still lead me to request a Hepatology consult, even in the setting of a previously defined autoimmune disease, i.e., SLE or Sjogrens.

After Hepatology assessment, and if there is a documented rheumatologic autoimmune disease, most often a liver biopsy has not been recommended. The autoimmune liver or biliary tree disease is assumed to be likely an overlap. The treatment of the primary autoimmune disease process may be increased, and autoantibodies and inflammatory markers followed for response.

Hepatology would usually follow the rheumatology patient annually. If the autoimmune disease is isolated to the liver, the patient would be managed by Hepatology and Primary Care.