<s>[INST] I have had elevated AST, ALT for a few years. Was made aware of it while on methotrexate therapy. I have not been on any meds at all for the past couple years. My AST/ALT remain high. Test from last week came back w/AST/ALT 180... Rheumatologist is referring me to as Gastro for a liver biopsy. In the last 3 years I have been diagnosed with Relapsing Transverse Myelitis. My tests for hepatitis have come back negative but rheumy wants to know if its autoimmune liver disease... Do ultrasounds, mris or car scans rule out or rule in a specific liver disease or is a biopsy the only way? Will Imuran help the liver disease and the RTM? [/INST] Hello, Thanks for the query to Chat Doctor. Forum. AST and ALT are a specific enzyme, no doubt, and value as you mentioned in query is also high. Value is high but not too high. If value is more than 300 U/L than we consider, that there is liver cell damage, otherwise, just due to damage to liver cell membrane (mind it I said MEMBRANE) there is increase in the value of AS T & A L T. So don't be panic as far concerned about raised level. So ultrasound, M R I and other liver specific enzymes value will reveal exact cause of liver damage, if any. Methotrexate if it uses in high dosage for long time may damage liver. Consult a physician and get opinion. Hope I have answered your question. If further any question I will help. Get well soon.  </s>