Autoimmune Hepatitis

Autoimmune hepatitis is chronic liver inflammation that's caused by the body's malfunctioning immune system. The same important process that identifies harmful invading bacteria and viruses and protects your body from them somehow becomes altered to attack and damage your liver cells. Why this begins isn't completely understood, but the leading theory is that it's triggered by some drug or infection in people who have inherited a trait that makes them more likely to develop an autoimmune disease. Autoimmune hepatitis, if untreated, can lead to cirrhosis and liver cancer.

Types of Autoimmune Hepatitis

Autoimmune hepatitis has two major forms (Type 1 and Type 2) but also can develop into less common variants. Type 1 autoimmune hepatitis can develop in anyone at any age (but usually occurs in young women and girls) and is the most common. Type 2 autoimmune hepatitis develops mostly in girls and young women.

Who's at Risk for Autoimmune Hepatitis?

About 70 percent of people with the disease are women, usually between the ages of 15 and 40. However, autoimmune hepatitis is an uncommon disease.

Diagnosing Autoimmune Hepatitis

Autoimmune hepatitis is diagnosed using blood tests and liver biopsy. The blood tests look for a variety of auto-antibodies, which are similar in ways to normal antibodies except they attack the body's own cells and tissues. For type 1, the most common circulating auto-antibodies are antinuclear antibodies (ANA). A more specific, but less prevalent auto-antibody (as compared to ANA) is the anti-smooth muscle antibody (ASMA). For type 2, the major auto-antibodies are called anti-liver-kidney microsomal-1 antibodies (ALKM-1 and ALC-1), but these are usually only found in children. Circulating levels of immunoglobulins are generally high in autoimmune hepatitis.

A liver biopsy helps to confirm diagnosis and determine the degree of liver damage. Imaging tests, such as ultrasound or CT (computerized tomography) also may help detect the presence of cirrhosis, which can be caused by autoimmune hepatitis.

Autoimmune Hepatitis Treatment

Autoimmune hepatitis is usually treated with prednisone (or a similar medication). However, this type of medication usually needs to be taken long-term and has significant side effects. Sometimes an additional drug is used such as azathioprine (Azasan, Imuran) which can help to reduce prednisone side effects. Fortunately, immediate treatment isn't necessary for everyone. Your physician will determine your treatment plan based on the severity of your symptoms and the results of your diagnostic tests.

Symptoms of Autoimmune Hepatitis

While it's possible to have no symptoms with autoimmune hepatitis, the most common symptom is fatigue. Other possible symptoms can be flu-like or similar to those of acute hepatitis, including jaundice.

Preventing Autoimmune Hepatitis

There is no effective prevention for autoimmune hepatitis. However it is possible to reduce the risk of development of cirrhosis and liver cancer with proper treatment.

_Sources:

_{Dienstag, JL. Chronic Hepatitis. In: AS Fauci, E Braunwald, DL Kasper, SL Hauser, DL Longo, JL Jameson, J Loscaizo (eds), Harrison’s Principles of Internal Medicine, 17e. New York, McGraw-Hill, 2008. 1966-1969.}

_{Krawitt EL, Bonis PA. Classification of Autoimmune Hepatitis. In: UpToDate, Basow, DS (Ed), UpToDate, Waltham, MA, 2009.}

_{Krawitt EL. Patient Information: Autoimmune Hepatitis. In: UpToDate, Basow, DS (Ed), UpToDate, Waltham, MA, 2009.}

_{Krawitt EL. Serologic Markers of Autoimmune Hepatitis. In: UpToDate, Basow, DS (Ed), UpToDate, Waltham, MA, 2009.}