About Autoimmune Hepatitis (Lupoid Hepatitis, Chronic Acute Liver Disease)
Over 3 million people have chronic hepatitis C in the U.S.
It is estimated that there are 130-200 million people infected with hepatitis C worldwide.
There are two types of autoimmune hepatitis. Type I (classic) is the most common and can occur at any age; half of those infected have other autoimmune disorders such as thyroiditis, rheumatoid arthritis, or ulcerative colitis.
Type 2 autoimmune hepatitis is most common in young females and often occurs with other autoimmune problems.
Why it is Problematic
If not treated, autoimmune hepatitis can lead to cirrhosis (excessive scarring) of the liver and, potentially, liver failure and death.
Causes and Risk Factors
It is unclear what causes the body's immune system to turn against the liver, but other autoimmune diseases seem to be contributing factors.
Other autoimmune disorders that are associated with autoimmune hepatitis are:
- Autoimmune thyroiditis (Hashimoto's thyroiditis)- a condition marked by the immune system attacking the thyroid gland
- Celiac disease- the abnormal reaction to gluten that affects the small intestine
- Hemolytic anemia—a condition in which the immune system attacks and breaks down red blood cells at a rate faster than the bone marrow can replace them, resulting in many complications and health problems
- Pernicious anemia- a condition associated with many autoimmune diseases, and occuring when lack of the B12 vitamin interferes with the body's ability to form new blood cells
- Rheumatoid arthritis- a condition in which the immune system attacks the lining of the joints, causing stiffness, pain, swelling and, possibly deformity and disability
- Ulcerative colitis- an inflammatory bowel disease causing severe watery and bloody diarrhea and abdominal pain
Risks for autoimmune hepatitis are increased if one is female, has a history of certain bacterial or viral infections, has used certain antibiotics or certain cholesterol-lowering medications, a family history of the disease, or the presence of another autoimmune disease.
Symptoms of autoimmune hepatitis are often absent. Symptoms can vary from mild to severe, and may come on gradually or suddenly. Common symptoms include:
- Abdominal discomfort
- Joint Pain
- Jaundice (yellowing of skin and whites of eyes)
- Itching (pruritis)
- Spider angiomas (abnormal blood vessels on the skin)
- An enlarged liver
- Nausea with or without vomiting
- Loss of appetite
- Dry eyes and mouth (Sjögren's syndrome)
- Skin rash
- Dark urine
- Amenorrhea (loss of menstruation)
A blood test is used to check for the presence of antibodies associated with autoimmune hepatitis. Diagnosis is often a matter of eliminating other forms of hepatitis.
A liver biopsy can help determine the degree and type of liver damage caused by autoimmune hepatitis.
Treatment and Prevention
Immunosuppressant drugs are used to control the immune system.
Doctors may recommend a treatment of corticosteroids, such as prednisone, in high doses to be followed by a course of low doses, for a minimum of 18 months and, potentially, for life. Corticosteroids can cause diabetes, bone thinning, broken bones, high blood pressure, cataracts, glaucoma, and weight gain. The drug azathiprine, (Imuran, Azasan), is sometimes used with a smaller dose of corticosteroids to reduce side effects.
In severe cases, a liver transplant may be necessary when medications have proven ineffective.
In the U.S., 100,000-200,000 individuals suffer from autoimmune hepatitis, with 70-80% of those being female.