It is not viruses, as in hepatitis forms A, B, or C, that cause this rare liver inflammation; rather, as in other autoimmune diseases, it is a misregulation of the body’s immune system. Autoimmune hepatitis (AIH) affects women about three to four times more often than men and is more common in middle age, but in principle can begin at any age, including childhood.
How does autoimmune hepatitis develop?
How autoimmune hepatitis develops has not yet been clearly clarified. It is assumed that environmental factors, toxins, or drugs can act as triggers, but above all, previous viral or bacterial infections. In addition, a genetic disposition probably also plays a role in the development of the disease. In the course of disease development, the immune system loses tolerance to its own liver tissue and the liver cells are destroyed by the body’s own T lymphocytes.
Autoimmune hepatitis: symptoms not very characteristic
Symptoms are usually uncharacteristic and may be limited to vague fatigue, decreased performance, nausea, and mild yellowing of the skin. Pain in the right upper abdomen and vague increase in temperature are also possible symptoms but are often not properly evaluated. Overall, the signs of the disease can be very discrete and barely noticed, but rapidly progressive liver inflammation and even liver failure can develop. Autoimmune hepatitis is the cause of chronic liver inflammation in 10 to 20 percent of cases.
Concomitant diseases of autoimmune hepatitis.
About 30 to 50 percent of those affected suffer from other concomitant diseases in which the immune system also attacks the patient’s own organs, such as:
- Rheumatoid arthritis
- White spot disease (vitiligo)
- Autoimmune thyroiditis (inflammation of the thyroid gland)
- Inflammation of the colon (ulcerative colitis)
Diagnosis of autoimmune hepatitis
It is important to make the diagnosis as early as possible, because a rapid start of therapy is crucial for the further course. To make the diagnosis, laboratory chemistry tests are first performed to rule out viral infection. In addition to an increase in transaminases and IgG immunoglobulins, the most important indication is autoantibodies directed against the patient’s own liver tissue. To confirm the diagnosis, a tissue sample is taken from the liver under local anesthesia for fine tissue examination.
Preventing serious liver damage through early diagnosis
So far, autoimmune hepatitis cannot be completely cured. That is, the defect in the immune system cannot be corrected. However, if diagnosed in time, the disease almost always responds very well to immunosuppressive therapy. This dampens the activities of the immune system or the inflammatory processes in the liver. The symptoms are thus alleviated and further damage to the liver prevented. However, if left untreated, cirrhosis of the liver will develop within a few years. Life expectancy is significantly reduced in such cases.
Autoimmune hepatitis: treatment with cortisone.
Two options are available for therapy: Either treatment with the cortisone preparation prednisolone or budesonide only, or a combination treatment of prednisolone or budesonide, respectively, and azathioprine. In patients of childbearing potential, cortisone treatment alone is usually chosen; otherwise, the combination is preferred. With the combination, the cortisone dose can be kept lower, which significantly reduces side effects. Because of the long-term treatment duration required, the side effects caused by cortisone should be kept to a minimum. These side effects include:
- Weight gain
- A bloated face (full moon face)
- Osteoporosis
- Gastric ulcers
- High blood pressure
- Steroid diabetes
- Skin problems such as acne
Long-term therapy required
A higher dose is started first and then reduced to the lowest possible maintenance dose. Treatment for at least two years is recommended before attempting to discontinue the medication.If laboratory chemistry values rise again, the medication must be taken again for several years.
Liver transplantation for ineffective therapy.
Some affected individuals may not respond to therapy, allowing autoimmune hepatitis to progress and cirrhosis to develop. In such cases, the last therapeutic option is liver transplantation.
