Iron high at 178 (40-150), tibc high normal at 439 (261-478). sometimes both are high. what causes this? % transferrin sat 41; ferritin 50 (11-204)

Follow it: Serum iron can go high after taking a few vitamin-and-mineral tablets or eating a nice steak. There's no need to pay attention to a "high-normal TIBC" -- unless you're way-out-of-range it means nothing. Iron is often somewhat abnormal in folks with a mix of autoimmune diseases like you have, especially RA, but in your case, I'd be glad that there seems to be no problem.