Autoimmune hepatitis is an autoimmune disease in which your body's immune system will attack the liver cells of the same organism. What might this cause? Well, because of this, the liver will become inflamed, and this will result in hepatitis. There are many symptoms and warning signs of autoimmune hepatitis, including fatigue, skin rash, an enlarged liver, and many more. Who is most at risk?
Researchers think that a genetic factor may predispose some people to these types of autoimmune diseases. Studies have also shown that women are most likely to develop autoimmune hepatitis, where they found out that about 70 percent of those with autoimmune hepatitis are women. Most autoimmune hepatitis patients are between the ages of 15 and 40. Autoimmune hepatitis is usually quite serious and, if it is not treated soon, it will continue to get worse over time. That is why it's incredibly important to catch autoimmune hepatitis in its early stages.
What exactly do you need to know about autoimmune hepatitis?
What is autoimmune hepatitis?
Autoimmune hepatitis could be type I or II. Type I is the most common form in North America, occurring at any age. It is more common among women than among men. About half of those with type I have other autoimmune disorders, such as thyroidosis, Graves' disease, Sjogren's syndrome, or autoimmune anemia.
Type II autoimmune hepatitis is less common, typically affecting girls aged 2 to 14, although adults can have it as well.
Autoimmune diseases
The primary function of the immune system is to protect the body from viruses, bacteria, and other invasive living organisms. Usually, the immune system does not react against the body’s own cells due to the “education” of lymphocytes in the thymus before birth. However, sometimes it mistakenly attacks the cells it is supposed to protect, so this response brings autoimmunity problems. Researchers speculate that certain bacteria, viruses, toxins, or some drugs can trigger an autoimmune response in people who are genetically susceptible to developing an autoimmune disorder.
Symptoms of autoimmune hepatitis
Fatigue is probably the most common symptom of autoimmune hepatitis. Others are enlarged liver, jaundice, itching, skin rashes, joint pain and abdominal discomfort.
People in advanced stages of the disease are more likely to have symptoms such as fluid in the abdomen (ascites) or mental confusion. Women may stop menstruating completely due to autoimmune hepatitis.
Symptoms of autoimmune hepatitis range from mild to severe. Because severe viral hepatitis (caused by a drug or certain antibiotics) has the same symptoms, your doctor will probably need some tests to reach an exact diagnosis. Your doctor should also review and rule out all your medicines before you get diagnosed with autoimmune hepatitis.
Diagnosis of autoimmune hepatitis
Your doctor will probably make a diagnosis based on your symptoms, blood tests, and liver biopsy; this is necessary if he wants to diagnose you with certainty. Routine blood test for liver enzymes can help reveal a pattern typical of hepatitis. Further tests, especially for auto-antibodies are something your doctor might need to diagnose autoimmune hepatitis. Antibodies are proteins made by the immune system to fight off bacteria and viruses, but in autoimmune hepatitis, the immune system makes antinuclear antibodies to smooth muscle cells or liver and kidney microsomes. The pattern and level of these antibodies help define the type of autoimmune hepatitis, whether you have autoimmune hepatitis type I or type II. Blood tests also help distinguish autoimmune hepatitis from viral hepatitis such as hepatitis B or C, or a metabolic disease such as Wilson’s disease.
Liver biopsy is procedure in which the doctor takes a tiny sample of your liver tissue, and examines it under a microscope. This diagnostic method can help accurately diagnose autoimmune hepatitis, and tell how serious it is. You will go to a hospital or outpatient surgical facility for this procedure, and get an appropriate diagnosis.
Treatment of autoimmune hepatitis
Treatment works best when you get an early diagnosis. With proper treatment, doctors are able to control autoimmune hepatitis. In fact, recent studies show that a sustained response to treatment not only stops the disease from getting worse, but it may actually reverse some of the damage done to your liver tissue.
The primary treatment is medicine to suppress or slow down an overactive immune system. Both types of autoimmune hepatitis receive treatment with daily doses of a corticosteroid called Prednisone. Your doctor may start you on a high dose of 20 to 60 mg per day, and lower the dose as the disease is controlled. The goal is to find the lowest possible dose that will control your disease without any side effects. Another medicine could also help – azathioprine or Imuran. This drug is common in treating autoimmune hepatitis. Like Prednisone, azathioprine suppresses the immune system, but in a different way. It helps lower the dose of Prednisone needed, thereby reducing its side effects, which is why your doctor may prescribe azathioprine, in addition to Prednisone, once your disease is under control. Most people with autoimmune hepatitis will need to take Prednisone, with or without azathioprine, for years. Some people take it for life because of this disorder.
In most cases, corticosteroids slow down the disease, but everyone is different. In about one out of every three cases, the doctor might choose to stop the treatment. However, it is important to carefully monitor your condition and promptly report any new symptoms to your doctor, because the disease may return and be even more severe. It happens especially during the first few months after stopping the treatment. In about 7 out of 10 people, the disease goes into remission, with a lessening of severity of symptoms. This is a common problem which happens within 2 years of starting the treatment. A portion of patients in remission will see the disease return within 3 years, so treatment may be necessary on and off for years. As previously said, in some cases life-long treatment may be necessary.
Side effects of medical treatment for autoimmune hepatitis
Both Prednisone and azathioprine have side effects, just as any other drug. Because you might need high doses of Prednisone to control your autoimmune hepatitis, managing side effects is very important. However, most side effects appear only after a long period of using these drugs. Some possible side effects of Prednisone are weight gain, anxiety and confusion, and thinning of the bones – a disorder called osteoporosis. Patients also report thinning of the hair and skin, diabetes, high blood pressure, or cataracts as side effects of medical treatment of autoimmune hepatitis. Azathioprine can lower your white blood cell count, and sometimes causes nausea and poor appetite as the main side effects. Rare side effects are allergic reaction, liver damage, and pancreatitis, or inflammation of the pancreas gland with severe stomach pain.
Alternative Treatment
People who do not respond to standard immune therapy or who have severe side effects may benefit from other immunosuppressive agents like Cyclosporine or tacrolimus, which is also an optional medical treatment for autoimmune hepatitis. People who progress to end-stage liver disease or liver failure may need a liver transplant as the only treatment available. Transplantation is a promising alternative that has a 1-year survival rate of 90 percent and a 5-year survival rate of 70 to 80 percent. However, many people still seek some alternative treatments for autoimmune hepatitis, although medical treatment and liver transplantation are the only ones that work.
In fact, combination of these medications is not universally effective and side effects are common. Only about 75% of patients who receive corticosteroids with or without azathioprine will enter remission from their autoimmune hepatitis condition.
This is the survey of studies looking at new therapies for patients with this disease. You can see the small number of patients who undergo studies that scientists have had until now. The first and the last study are really looking at alternatives to azathioprine as corticosteroid-sparing agents in autoimmune hepatitis therapy. These studies looked at 6-mercaptopurine, which is the active moiety to which azathioprine metabolize. The study wanted to research what happens if therapy contains something else instead of azathioprine for those patients. The study was well-worth for those few patients who cannot tolerate azathioprine. This looks like an acceptable alternative to valuable therapy for these three patients.
Cyclophosphamide, or Cytoxan, which is a cancer cytotoxic drug, was also treatment option in three patients along with corticosteroids (instead of azathioprine). It appeared to offer some benefit as an alternative therapy. Cyclosporine and ursodeoxycholic acid have been tested as primary therapies, but again just in a very small number of patients in both of these series. Cyclosporine has a number of toxicities but in this study of five patients, four of them entered remission. The fifth patient required a liver transplant, as the only treatment option available. Therefore, although scientists are still trying to find an appropriate alternative therapy for autoimmune hepatitis, medical therapy and liver transplantation is still the best choice you and your doctor could have.