Autoimmune Hepatitis

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Autoimmune illnesses commonly affect women. Hepatitis is inflammation of the liver that can be caused by viral infection, chemical toxicity, or an autoimmune process which is associated with genetic factors. It is important to get the correct diagnosis because different causes require different treatments.

Autoimmune hepatitis occurs in children and adults of all ages, mostly in females. If untreated, it has a high mortality rate of up to 50 percent within five years of diagnosis. However, the vast majority of patients achieve complete remission with immunosuppressive therapy. The course of the disease tends to be relapsing and remitting, so it requires ongoing monitoring.

The initial symptoms are often non-specific, including:
1. Fatigue
2. Lethargy
3. Malaise (often called flu-like)
4. Anorexia or loss of appetite
5. Nausea
6. Abdominal pain
7. Itching
8. Pain in the small joints

A physical examination may reveal enlargement of the liver and spleen, and jaundice (yellowing of the skin and eyes). Blood tests and liver biopsy are used to make the diagnosis.

The standard treatment is corticosteroids and azathioprine. Dr. Albert Czaja of the Mayo Clinic reports that choosing the optimum amount of treatment involves some difficult decisions, since the side effects of the drugs can be almost as serious as the disease. The critical decision points are:
1. Treating acute severe hepatitis with corticosteroids. Factors that favor steroids alone include severe loss of white blood cells, pregnancy, and short treatment times. Factors that favor a lower dose of corticosteroids plus azathioprine include elderly patients, osteoporosis, diabetes, obesity, emotional instability, hypertension, and longer treatment times.
2. Treatment of asymptomatic or autoantibody-negative autoimmune hepatitis. It is difficult to tell which patients will progress to liver damage.
3. Treating overlap syndromes. Other liver conditions may be present.
4. When to stop treatment. Remission may be long term, but the disease can relapse after treatment is stopped.
5. Restarting treatment after relapse. The condition must be re-evaluated.
6. Treating adverse responses. Treatment failure, incomplete response, and drug toxicity are all possibilities that justify a modification of treatment.
7. Empirical salvage therapy. Other immunosuppressive drugs may be used if the standard therapy is not successful.
8. Treating the elderly. These patients need special attention for drug side effects.
9. Treatment during pregnancy. Both the disease and the drug therapy present risks to the developing fetus.

The Mayo Clinic web site offers more information on autoimmune hepatitis at http://www.mayoclinic.com/health/autoimmune-hepatitis/DS00676.

References:

Teufel A et al, “Update on autoimmune hepatitis”, World J Gastroenterol 2009 March 7; 15(9): 1035-41.

Czaja AJ, “Difficult treatment decisions in autoimmune hepatitis”, World J Gastroenterol 2010 February 28; 16(8): 934-47.

Linda Fugate is a scientist and writer in Austin, Texas. She has a Ph.D. in Physics and an M.S. in Macromolecular Science and Engineering. Her background includes academic and industrial research in materials science. She currently writes song lyrics and health articles.

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