How do you monitor patients with incidentally found high titer anti-smooth muscle antibodies without stigmata of liver disease?  

I have quite a few SLE patients with ASMA who do not have any signs of hepatic disease (though I did not do bxs in those with normal hepatic transaminases). They are very common in the general population. I have down in my notes a prevalence of 16%. However, there are studies showing prevalences ...

Asymptomatic disease is part of the spectrum of autoimmune hepatitis. Periods of subclinical disease can also exist for a long period of time. I, therefore, will consult my hepatology colleagues as to whether or not a liver biopsy is warranted and to help guide monitoring. 

I agree with the information already submitted and will add a few comments. Not certain why the anti-smooth muscle antibody was tested in the absence of elevated transaminases. This then begs the issue of the differential of elevated AST and or ALT in SLE which is quite broad but includes lupoid hep...