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Autoimmune hepatitis is a liver condition characterized by inflammation caused by the immune system attacking liver cells. If left untreated, it can lead to liver failure and scarring of the liver known as cirrhosis. However, early diagnosis and treatment of autoimmune hepatitis often involve the use of immunosuppressive drugs to control the immune system. In cases where drug treatments are ineffective or if the disease has progressed significantly, a liver transplant may be considered as a viable option.
This chronic liver disease originates from an error in the immune system’s function. Instead of targeting infections in the liver tissues, the immune system mistakenly directs antibodies towards healthy liver cells, resulting in inflammation, known as hepatitis. Over time, the persistent inflammation caused by autoimmune hepatitis can cause severe damage to the liver. Similar to other forms of chronic hepatitis, it can lead to the development of cirrhosis. Medical intervention can help manage the inflammation and prevent the occurrence of complications. However, during the early stages of the disease, individuals may not experience noticeable symptoms.
There are two primary forms of autoimmune:
- Type 1 autoimmune: hepatitis is the most common and can occur at any age. About half of the individuals with type 1 autoimmune hepatitis also have other autoimmune disorders, such as celiac disease, rheumatoid arthritis, or ulcerative colitis.
- Type 2 autoimmune hepatitis: while also affecting adults, is more prevalent in children and young people. This type of autoimmune hepatitis may be accompanied by other autoimmune diseases.
Symptoms
Autoimmune hepatitis symptoms can appear rapidly and differ from person to person. In the early stages of the condition, some persons have few, if any, noticeable issues while others show signs and symptoms like:
- Abdominal discomfort or pain
- Fatigue
- Jaundice, yellowing of the skin and whites of the eyes.
- Enlarged liver and swollen abdomen.
- Abnormal blood vessels on the skin (spider angiomas)
- Skin rashes or itchy skin
- Joint pains
- Loss of menstrual periods
- Dark colored pee or pale colored stool
- Loss of appetite or nausea
- Confusion, disorientation, or drowsiness
It is recommended to seek medical attention if someone experience any signs and symptoms of autoimmune hepatitis.
Causes
Autoimmune hepatitis is a condition where the immune system, typically responsible for targeting viruses and bacteria, mistakenly attacks the liver. This immune attack results in ongoing inflammation and significant damage to liver cells. The exact reasons for this self-directed immune response are not fully understood, but researchers speculate that a combination of genetic factors controlling immune system function and exposure to certain viruses or medications may play a role. In autoimmune diseases, including autoimmune hepatitis, the immune system erroneously identifies the body’s own cells as a threat and continues to attack them, leading to chronic inflammation in a particular area of the body. In the case of autoimmune hepatitis, the immune system produces specific antibodies that target particular types of liver cells.
Risk factors
The following factors could increase the risk of developing autoimmune hepatitis:
- Gender: Autoimmune hepatitis can affect both sexes, but women are more likely to get the condition.
- Heredity: There is evidence that autoimmune hepatitis likelihood can occur in families.
- History of certain infections: Herpes simplex, the Epstein-Barr virus, or the measles can all cause autoimmunity hepatitis. Hepatitis A, B, or C infection is also a factor in the condition.
- Medications: Nitrofurantoin (for urinary tract infections), Minocycline (for acne), Atorvastatin (for high cholesterol), and Isoniazid (an antibiotic) have all been linked to drug-induced autoimmune hepatitis.
- Other autoimmune disease: A person may be more susceptible to developing autoimmune hepatitis if they already have an autoimmune condition, such as celiac disease, rheumatoid arthritis, or hyperthyroidism (Graves disease or Hashimoto’s thyroiditis).
Diagnosis
The patient may or may not have symptoms or indicators of AIH. Physical examination and some standard tests, such as imaging and blood testing, will be the first things a healthcare provider recommends.
- Blood tests: A thorough metabolic panel blood test will reveal signs of liver illness. Antibody testing on a blood sample can distinguish between viral and other illnesses with similar symptoms and autoimmune hepatitis. Determine the specific form of autoimmune hepatitis you have with the help of antibody tests.
- Liver biopsy: A liver biopsy is conducted by a healthcare provider to confirm the diagnosis and to ascertain the kind and severity of liver damage. A thin needle is inserted into the liver through a tiny skin incision during the surgery to remove a small amount of liver tissue. The sample is subsequently delivered to a lab for evaluation.
Treatment
The goal of treatment is to reduce or stop the immune system’s attack on the liver, regardless of the type of autoimmune hepatitis. This might slow the disease’s development. They will require immunosuppressive drugs to achieve this goal. Prednisone is typically the first course of treatment. Prednisone may be advised in conjunction with azathioprine (Azasan, Imuran), another drug.
Prednisone can have a number of serious adverse effects, particularly if it is used for an extended period of time. These include diabetes, osteoporosis, osteonecrosis, high blood pressure, cataracts, glaucoma, and weight gain.
For the initial month of treatment, healthcare providers frequently prescribe prednisone at a high dosage. Once they’ve reached the lowest dose that can control the disease, they progressively reduce the dose over the following several months to reduce the chance of side effects. Azithromycin is a supplement that lessens the negative effects of prednisone.
Even though the patient may go into remission a few years after treatment, the disease frequently recurs if the medication is stopped. Depending on the circumstance, they can need ongoing care.
Liver transplant
When medications are unable to stop the advancement of the disease or when irreversible scarring (cirrhosis) or liver failure occurs, the final resort is a liver transplant.
A liver transplant involves the removal of your diseased liver and its replacement with a healthy liver from a donor. Deceased organ donors are most commonly used as a source of livers for transplantation. However, in certain situations, a living-donor liver transplant may be an option. In a living-donor liver transplant, you receive a portion of a healthy liver from a living donor. Both the donated liver and the remaining portion of your liver begin regenerating new cells almost immediately.
