When white blood cells (lymphocytes) erroneously attack liver cells, they cause inflammation and damage to the liver. This results in the condition autoimmune hepatitis. There are two types of autoimmune hepatitis.
Type 1 autoimmune hepatitis is the most common type of the disease. Although it can affect anyone of any age, it most commonly develops in women aged around 45.
Type 2 autoimmune hepatitis primarily affects young girls between the ages of two and fourteen, and is much less common than type 1 hepatitis.
In many cases of autoimmune hepatitis the symptoms develop gradually over weeks or months. Often at the time of diagnosis there are very mild symptoms, or no symptoms at all.
How Is Autoimmune Hepatitis Diagnosed
The presence of hepatitis is often discovered when patients are undergoing medical tests for unrelated disorders.
Blood tests called liver function tests give a general guide as to whether the liver is inflamed and how well it is functioning. These tests are able to confirm the presence of hepatitis, but not the cause of the disease.
Other tests and a liver biopsy are able to identify the type of cells involved in the inflammation. This can rule out other causes of the hepatitis, and help confirm the diagnosis of autoimmune hepatitis.
Symptoms Of Autoimmune Hepatitis
Symptoms can range from minor to severe, and can include fatigue, joint and muscle pain, feeling very unwell, vomiting and for women loss of menstruation. Jaundice can develop if inflammation is severe.
Persistent untreated inflammation causes liver damage and may lead to scarring of the liver, a condition known as cirrhosis. This can result in serious problems and liver failure in severe cases.
Complications Of Autoimmune Hepatitis
Cirrhosis of the liver occurs when liver tissue is damaged, resulting in fibrosis, or scar tissue. In the early stages it rarely exhibits signs or symptoms of the disease, and worsens steadily over time. However as liver function gradually deteriorates , the problem becomes serious.
Liver failure occurs when the extent of damage to liver cells prevents the liver from functioning adequately. A liver transplant usually becomes necessary.
Treatment Of Autoimmune Hepatitis
With early and ongoing treatment for autoimmune hepatitis the prognosis is very good, and the disease is manageable if treatment protocols are followed.
Early treatment helps to control inflammation and reduces the risk of complications. Long-term treatment can stop the disease from escalating and may even reverse some of the damage to the liver.
Steroid medication (usually prednisolone) is the usual first treatment, as steroids are good at reducing inflammation. A high dose is usually needed for about the first month of treatment. To reduce the risk of side effects , the dose is gradually lowered over the next few months.
Monitoring will allow the doctor to ultimately determine the lowest effective maintenance dose. Adding an immune system suppressor (azathioprine) also helps to avoid the side effects of prednisolone.
Most people need to continue medication for one or two years. Even if there are periods of remission, the disease often reappears if the treatment is discontinued. Some people need to remain on medication for life.
Causes Of Autoimmune Hepatitis
Evidence suggests that a predisposition to autoimmune disease may run in families. Already having an autoimmune disease such as rheumatoid arthritis, Celiac or Grave’s disease could make you more likely to develop autoimmune hepatitis.