Non-alcoholic steatohepatitis (NASH) is an entity characterised by mild abnormal liver function tests, a negative serological investigation, and histopathological findings similar to those seen in alcohol induced liver disease in patients who do not consume significant amounts of alcohol. Patients are usually asymptomatic but may complain of fatigue, malaise, or vague right upper quadrant pain. A low calorie diet is helpful in most of these patients. We present a case report of a patient with arthritis associated with NASH, which resolved completely after the introduction of a low calorie diet.

A 37 year old man presented with symmetrical arthritis during the past year affecting the elbows, wrists, shoulders, and knees. He had morning stiffness, which resolved after a one hour period of activity. On physical examination there was moderate tenderness of the elbows and wrists without swelling or limitation of the range of motion. Liver and spleen were not enlarged. Laboratory studies showed increased liver enzymes; aspartate aminotransferase 53 IU (normal <49 IU), alanine aminotransferase 98 IU (normal <51 IU), …