The ABC’s of Autoimmune Hepatitis

Knowing the facts of a disease should be of primary importance when a diagnosis is given. There are several forms of hepatitis, knowing the particulars about your specific one is vital to your health and your prognosis.

Autoimmune hepatitis is a disease in which the body’s immune system attacks liver cells. This immune response causes inflammation of the liver, also called hepatitis. Researchers think a genetic factor may make some people more susceptible to autoimmune diseases.

The Mayo Clinic states, “Although the cause of autoimmune hepatitis isn’t entirely clear, some diseases, toxins and drugs may trigger autoimmune hepatitis in susceptible people, especially women.” About 70 percent of those with autoimmune hepatitis are female.

The disease is usually quite serious and, if not treated, gets worse over time. Autoimmune hepatitis is typically chronic, meaning it can last for years, and can lead to cirrhosis—scarring and hardening—of the liver. Eventually, liver failure can result.

Autoimmune hepatitis is classified as type 1 or type 2. Type 1 is the most common form in North America. It can occur at any age but most often starts in adolescence or young adulthood. About half of those with type 1 have other autoimmune disorders. Type 2 autoimmune hepatitis is less common, typically affecting girls aged 2 to 14, although adults can have it too.

A diagnoses of autoimmune hepatitis is based on symptoms, blood tests, and a liver biopsy. Symptoms of autoimmune hepatitis range from mild to severe. Because severe viral hepatitis or hepatitis caused by a drug—for example, certain antibiotics—have the same symptoms as autoimmune hepatitis, tests may be needed for an exact diagnosis. Doctors should also review and rule out all medicines a patient is taking before diagnosing autoimmune hepatitis.

Fatigue is probably the most common symptom of autoimmune hepatitis. Other symptoms include: an enlarged liver; jaundice; itching; skin rashes; joint pain; abdominal discomfort; spider angiomas, or abnormal blood vessels, on the skin; nausea; vomiting; loss of appetite; dark urine; and/or pale or gray-colored stools. Women may also stop having menstrual periods

People in advanced stages of the disease are more likely to have symptoms related to chronic liver disease, such as fluid in the abdomen—also called ascites—and mental confusion.

Treatment works best when autoimmune hepatitis is diagnosed early. With proper treatment, autoimmune hepatitis can usually be controlled. In fact, studies show that sustained response to treatment stops the disease from getting worse and may reverse some of the damage.

The primary treatment is medicine to suppress, or slow down, an overactive immune system. The most common drug prescribed for autoimmune hepatitis is prednisone. Another medicine, azathioprine (Imuran) is also used to treat it. Like prednisone, azathioprine suppresses the immune system.

In about 70% of patients, the disease goes into remission within 3 years of starting treatment. Remission occurs when symptoms disappear and lab tests show improvement in liver function. Some people can eventually stop treatment, although many will see the disease return. People who stop treatment must carefully monitor their condition and promptly report any new symptoms to their doctor. Treatment with low doses of prednisone or azathioprine may be necessary on and off for years, if not for life.

Some people with mild forms of the disease may not need to take medication. Doctors assess each patient individually to determine whether those with mild autoimmune hepatitis should undergo treatment.

A liver transplant may be an option when autoimmune hepatitis doesn’t respond to drug treatments or when liver disease is advanced.

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