Autoimmune hepatitis is a liver disease caused when the body’s immune system destroys liver cells. In many ways, this form of autoimmunity is a mystery. Doctors have not been able to determine what makes the body turn on itself and cause liver inflammation. In this article, we’ll look at the symptoms of this disease and how it’s treated.
What causes the body’s own immune system to attack the liver is not yet known. It appears that certain types of white blood cells misread liver cells as foreign substances and start attacking these cells. The type of damage that follows is known as chronic hepatitis. A number of other conditions can cause identical patterns of liver damage. These include viruses, such as hepatitis B and hepatitis C, certain types of drugs, and an overload of certain metals, such as copper and iron in the liver. There are also much rarer causes of chronic active hepatitis.
Autoimmune hepatitis is usually quite serious and, if not treated, then acute liver failure can occur. The disease is typically chronic, meaning it can last for years, and can lead to cirrhosis of the liver. Eventually, liver failure can result. It is classified as type 1 or type 2. Type 1 is the most common form in North America. About half of those with type 1 have other autoimmune disorders, such as type 1 diabetes, an inflammation of blood vessels in the kidneys, Graves’ disease and ulcerative colitis. Type 2 is less common; typically affecting girls aged 2 to 14, although adults can have it too.
Although the cause isn’t clear, the treatment seems to be effective. Some patients with very mild or inactive autoimmune hepatitis may not need any type of active treatment. When active drug treatment is needed, corticosteroids are the treatment of first choice. They are completely different from anabolic steroids used to build muscle mass. Corticosteroids, such as prednisone, are potent anti-inflammatory drugs that will reduce inflammation in all sites, including the liver. Approximately 90% of patients require some form of treatment to maintain remission after the steroids have reduced the initial inflammation. About 10% do not require any maintenance therapy and remain in remission with no symptoms and no active inflammation in the liver, for many years. Due to the variable intensity of the disease, even with maintenance treatment, patients may suffer from relapses of inflammation periodically. Such relapses are usually treated by a temporary course of steroids.
Any type of liver injury or disease is very serious so early diagnosis and treatment is essential. With proper treatment, autoimmune hepatitis can usually be controlled. In fact, studies show that sustained response to treatment stops the disease from getting worse and may reverse some of the damage. Some people with mild forms of the disease may not need to take medication. Doctors assess each patient individually to determine whether those with mild cases should undergo treatment.
