Kickas.org Forums Ankylosing Spondylitis General Discussion #1 AS Web Support Group Hives and abnormal Liver blood test results

Hi everyone.

Lately I've been experiencing hives pretty much all over my body. Initally I just noticed an itch, there wasn't really any redness. About a week after the itch started, thats when the hives started appearing. And now they are basically showing up anywhere on my body that I rub or put pressure on. I saw a dermatologist on tuesday and he ordered a liver panel which came back abnormal. My ALT was 66, AST was normal. My total bilrubin was also raised, being 1.5, the normal is supposed to be less than 1.1.

I'm currently on Methotrexate, naprosyn, and I usually take Humira weekly, although it has been almost 3 weeks since my last dose of Humira due to a screw up by CVS.

Has anyone here experienced anything like this? This a new symptom for me and the liver results are little upsetting to me.

I have elevated ALT and to a lesser extent elevated AST. When my gastroenterologist and I talked, he ran a bunch of tests to rule out the less obvious, and had me get an ultrasound test done, and for me, sure enough, its NAFLD, as they found "fatty infiltration" in the liver on ultrasound.

But for me, its an obvious reason. I have diabetes and am overweight for me. Insulin resistance leads to an increase in insulin production which leads to an increase in storing fat. When the fat cells get full, then the fat goes to the liver.

My grandmother died from cirrhosis of the liver and my aunt developed cirrhosis due to the NAFLD due to the diabetes.

I'm lucky we caught it in its early stages. My ALT never went about 3x normal (yours is only about 2x normal). I had time / have time to turn it around. For me, weight loss is key. I was 150 lbs, now closer to 140 lbs, the liver enzymes get better when i lose the weight. My body just can't handle being over 140 lbs.


Another common cause of liver enzymes going up is certain medications. One reason I didn't start SSZ but went straight to humira, because as we (my rheumy and I) were deciding SSZ? or Humira?, the liver tests starting showing NAFLD.

I see you are on MTX, that could be one culprit.

I'd ask your doctor (a good gastroenterologist or a liver specialist) to do the series of blood work to rule out anything more serious, and have an ultrasound of your liver too, its totally noninvasive, and can tell you a lot.


as for the hives, not sure what you mean by hives, but i'll share:

prior to humira or even methylpred, each late summer, I'd flare terribly! During my worst flares, I'd get these red itchy itchy itchy bumps / rash mostly on my lower legs (shins and calfs) and the tops of my feet, also some but less on the backs of my hands and tops of my lower arms. I have a dermatologist and once he discovered I have spondy, he realized that what looked like the worst case of being attacked by mosquitos (but I wasn't, as they'd erupt indoors at my desk, while sleeping, in my recliner, etc). Turns out it was erythema nodosum.

I don't get it anymore since methylpred and now humira.

But apparently a pretty common, as my rheumy said, "general autoimmune / autoinflammatory symptom". Non-descript to spondy or any other autoimmune / autoinflammatory disease, but rather a general common symptom.

Hope that helps.

Well I want to update this since I was in the ER over the weekend. My hives have been getting worse even though I'm currently taking antihistamines. Early sunday morning I had a raging headache centered behind my eyes, probably one of the worst I've ever had. At the same time I was also having chest tightness radiating into my throat. Because I've had the hives for about two weeks, I thought I might be having having some sort of severe allergic reaction. So after much debate with my Fiancee I dragged myself into the ER. Luckily it seemed to be nothing that serious. ER docs guess; severe heartburn for the chest pain. Allergic reaction for the hives, although they of course had no idea what was causing it. Just handed me some benedryl and some maalox. Also a tab of fiorecet for the headache.

While I was there they rechecked my metabolic panel. This time my liver enzymes and bilirubin were back to within normal ranges. 26 for the AST and 51 for the ALT. Although my blood glucose was 114 and creatinine 1.4 (1.2 is the high limit). I'd probably attribute those last two values just to my somewhat recent evening meal. Still I plan on getting a little more exercise, just in case.

So still no idea whats causing these damn hives. They just keep getting worse and they are literally everywhere. Luckily, unless I accidentally rub or itch my skin, I'm not usually actively breaking out. So I'm trying not to rub my face. Trying not to look like a tomato. I just started taking 25 mg hydroxezine in addition to the 10 mg loretadine I'm taking daily as well. So far the antihistamines have had little to no effect however.

Also, thanks for the reply Sue. I'm going to be scheduling an abdominal ultrasound as well. I'm also going to see an Allergist this weds and a gastroenterologist on the 17th. I haven't really been exercising, well, at all for a while. So I wouldn't be surprised if that was at least partly responsible for some of my problems. I'm not overweight, I'm just really out of shape. I need to fix that.

Oh and here's an example pic of hives, not mine, but very similar:
http://hivespictures.org/large/71/Urticaria-Hives-Pictures-3.jpg

Luckily my back pain hasn't been too bad lately, so with my blood work being kind of wonky I got the Ok from the rheumy to suspend my humira and MTX for at least a little while until I get my bloodwork done again sometime next month. Crossing my fingers, but for the time being, good rest, stretching, and the low fodmap diet seem to be helping with my pain pretty well. Although I know another flare is just around the corner. Right now I'm just hoping these hives stop getting worse and start going away.

Another update. Saw an Allergist yesterday. She said I have Symptomatic Dermographism, which apparently is somewhat common. Apparently something like 1 in 20 people have it. Mine is just pretty severe right now. Basically whenever something rubs against my skin, that part of my skin breaks out in hives. The hives go away after about an hour but while they are there, they're pretty itchy and very red. My entire body is affected, so even a light little touch on my face will leave red blotch and the area around my shirt collar is almost unbearable. I even get hives between my fingers from the skin rubbing together.

So now I'm taking antihistamines. And apparently I could be taking them for a very long time as this condition doesn't usually go away for years. If it goes away at all. O well.