It Has been a year since I was diagnosed with PSC. I was wondering if Most of you have antibodies present in your blood test. My test results show that I have normal levels of Antibodies present related to the biliary tract, but I have high antibodies related to ulcerative colitis and Crohn’s. My functional doctor finds it odd that I do not present any antibodies related to the liver and questions whether my PSC diagnosis is correct. I previously (20 years ago) had ulcerative colitis until I had surgery to remove my colon. I also had WBCs present in my stool sample indicating small bowel inflammation somewhere. As my PSC is considered in the very early stage, I was only diagnosed through an MRCP and a spike in my bilirubin which has now returned to normal. My liver biopsy came back fine. Any comments would be appreciated!

The daughter (child) was a positive p-anca. other antibodies in the norm. High IgE, IgM slightly above the norm.

From what I have experienced PSC is usually seen in MRCP as well as high Alkaline phosphate levels. I have had this for almost 15 years and have had ups and downs with all liver enzymes but my Alkaline Phosphate is always above normal. I did my own research to find a specialist that is experienced with this(after years of misdiagnosis).

Unlike with PBC and AIH, I don’t believe there are antibodies that are significantly correlated with PSC. I’ve tested negative for all of the common liver/IBD antibodies. As mentioned, PSC is typically diagnosed by LFTs and imaging.

Out of curiosity, when you say antibodies, which type do you mean? anca? AMA? There are different flavors of PSC as well.

Have you been tested for AMA?

pANCA is most commonly associated with ulcerative colitis (UC)

negative pANCA and postive ASCA suggest Crohn disease

ANCA assay results are positive in 60%-80% of patients with ulcerative colitis. The presence of pANCA is associated with an earlier need for surgery. The finding of ANCA is roughly 50% sensitive, is 94% specific, and has a 76% positive predictive value for ulcerative colitis

ASCA is more highly associated with Crohn disease and is present in 60% of cases, whereas ASCA is present in only 12% of patients with ulcerative colitis. ANCA is present in only about 40% of patients with Crohn disease. ANCA and ASCA titers are not correlated with disease activity.

A large number of autoantibodies have been detected in PSC patients. I believe that is why it is usually diagnosed by imaging alone. They tend not to depend on antibodies.

Often with liver biopsy they do not get the typical onion skin fibrosis sample. They have to be lucky from my understanding. Again, that’s why imaging is so very important.

Also, you might want a second opinion on Crohn’s if it is just localized in your colon especially if you have pancolotic UC. It makes it very hard to diagnose.

I hope that helps. I know I threw a bunch of info in there. If you haven’t received a second opinion, I would encourage you to do so. If you were diagnosed by GI specialist, I would encourage you to seek out a hepatologist at a teaching hospital.