Written by David Bernstein, MD, FACP, FACG Friday, 19 February 2010 00:00
Autoimmune hepatitis is a common form of chronic liver disease that is quite commonly encountered in our area. As there are no specific markers for this condition and it is seldom considered by physicians, its diagnosis is often delayed or not made at all. This chronic condition is a result of alterations in the body’s immune system which lead to the production of specific chemicals that attack liver cells. These specific chemicals have yet to be identified, however the condition of autoimmune hepatitis is well described. Simply said, this condition is a result of an enhanced immune response directed at the liver.
Autoimmune hepatitis classically affects young woman in their second and third decade of life. Having said this, however, this condition may present at any age. People with autoimmune hepatitis may seek help from a physician because they have been noted to have very high liver chemistries or even mildly elevated liver tests. About 50 percent of people will present with liver chemistries in the high hundreds or even in the thousands. This scenario is no different than the presentation of any form of acute hepatitis including hepatitis A and B and any drug-induced hepatitis. A person typically complains of fatigue, loss of appetite and weight loss. He or she may become jaundiced or yellow. These complaints are also no different than any other form of acute hepatitis. Autoimmune hepatitis is diagnosed after all these other forms of acute liver disease have not been found to be the cause. These episodes of abnormal liver tests can spontaneously resolve and recur at a later time. Despite the fact that there are no specific markers for autoimmune hepatitis, there are certain blood tests which are typical for this condition. The serum total protein is usually very high and the serum immunoglobulins (chemicals made by the body as part of the immune system response) are also elevated. Autoantibodies such as the anti-smooth muscle antibody are usually positive. These tests are generally sufficient to make the diagnosis of autoimmune hepatitis and once the diagnosis is made, therapy should be initiated.
A liver biopsy is essential in the evaluation of autoimmune hepatitis. About 50 percent of people who first show signs of autoimmune hepatitis will already have cirrhosis on a liver biopsy. This is important for both the patient and physician to know. Classically, the liver biopsy in autoimmune hepatitis is filled with plasma cells, the cells in the blood stream which are involved in the body’s immune system.
The most commonly described person with autoimmune hepatitis is a young woman with a history of acne, an abnormal menstrual cycle and hirsuitism. Most patients, however, do not give this classic history and simply have the blood tests consistent with the disease. Other conditions associated with autoimmune hepatitis include arthritis, skin diseases, kidney disease, lung disease, thyroid disease and anemia, to name just a few.
The treatment of autoimmune hepatitis is aimed at modulating the immune system. Therefore, the initial treatment is a steroid such as prednisone which is very slowly tapered over a long time course. As steroids have significant side effects, especially when given over a long period of time, other immune modulators such as azothioprine are given in an effort to reduce steroid dosages. If therapy is unsuccessful and the patient develops complications of cirrhosis, liver transplantation is an option in these patients although the condition may recur in the new liver.
(Disclaimer: The views and opinions represented are those of the author and meant for informative purposes only. For your specific questions, consult your physician.)