Autoimmune Hepatitis

Autoimmune hepatitis is inflammation of the liver that happens when the body’s immune system starts to attack the liver instead of harmful invaders like viruses and bacteria. The body can’t tell the difference between the harmful invaders and normal body tissue. This attack on the liver doesn’t go away (chronic) and can cause serious damage to the liver cells.

There are two main forms of autoimmune hepatitis:

  • Type 1 (classic) – is the most common type. It can occur at any age. About half of the people with type 1 have other autoimmune disorders like thyroiditis, rheumatoid arthritis or ulcerative colitis.
  • Type 2 – Although adults can develop type 2, it is most common in girls and often occurs with other autoimmune problems.

Several factors may increase your risk of autoimmune hepatitis:

  • Being female – both men and women can develop autoimmune hepatitis but it is more common in females.
  • Age – can occur at any age.
  • A history of certain infections – certain medications, such as antibiotic monocycline and the cholesterol medication Lipitor (atorvastatin) have been linked to autoimmune hepatitis.
  • Heredity – may run in families.
  • Having an autoimmune disease – people who already have an autoimmune disease may be more likely to develop autoimmune hepatitis.

Symptoms

Signs and symptoms can range from minor to severe and may come on suddenly or develop over time. Some people have few, if any, problems in the early stage of the disease, while others experience signs and symptoms that include:

  • Fatigue
  • Abdominal discomfort
  • Joint pain
  • Itching
  • Yellowing of the skin
  • Enlarged liver
  • Abnormal blood vessels on the skin
  • Nausea and vomiting
  • Loss of appetite
  • Skin rashes
  • Dark-colored urine
  • In women a loss of menstruation

Tests and diagnosis

Tests and procedures used to diagnose autoimmune hepatitis include:

  • Blood test – a sample is takes to check for antibodies from autoimmune hepatitis, viral hepatitis, or other disorders that have similar symptoms.
  • Liver biopsy – a thin needle is passed into the liver through a small incision in the skin to remove a small amount of liver tissue. The sample is sent to a lab to determine if it is autoimmune hepatitis.

Treatment

Whatever the type of autoimmune hepatitis, the goal of treatment is to slow or stop the body’s immune system from attacking the liver. This may slow the disease down. Medications that are used to treat autoimmune hepatitis include:

  • Prednisone – A high dose is usually given at the beginning of treatment. The dose is later lowered to control the disease over a few weeks. Most people need to stay on prednisone for at least 18-24 weeks, and some for their entire life.
  • Azathioprine (Azasan, Imuran) – is sometimes used along with prednisone. Using both medicines may allow a smaller dose of prednisone to be used to reduce side effects.
  • Other immunosuppressants – if prednisone or azathioprine doesn’t help, other drugs may be needed.
  • Liver transplant – when medications don’t stop the progress of the disease, or there is irreversible scaring (cirrhosis) or liver failure, the remaining treatment is a liver transplant.