A 45-year-old male presents with a 6-month history of fatigue and joint pain. Recent blood tests show slightly elevated alanine aminotransferase (ALT) and aspartate aminotransferase (AST), but other liver function tests are normal. His rheumatoid factor is also mildly elevated. What are the potential diagnoses and next steps?
The combination of joint pain, fatigue, mildly elevated liver enzymes, and rheumatoid factor could suggest a diagnosis of rheumatoid arthritis (RA) with mild liver involvement, or potentially another autoimmune condition. It's also important to rule out viral hepatitis, which can present with similar findings. Further testing should include anti-citrullinated protein antibodies (ACPA), an important marker for RA, as well as hepatitis B and C serologies. Depending on these results, the patient may benefit from a consultation with rheumatology or hepatology.