Have you ever thought that your own body's defense system, the immune system, would start attacking your own liver? It's surprising, isn't it? But, autoimmune hepatitis is exactly that kind of condition. Although this may seem a bit complicated, let's talk about it simply, in a way that you can understand.
What is autoimmune hepatitis?
Simply put, autoimmune hepatitis is a long-term disease that affects your liver. It starts with a small mistake in your body's defense system, the immune system . Think of it this way: our immune system is like an army that protects our country. Its job is to fight off foreign invaders like germs and viruses. But, in autoimmune hepatitis, this army, the immune system, mistakenly thinks that its own healthy liver cells are the enemy and starts attacking them.
When the immune system attacks the liver tissue in this way, it causes inflammation of the liver, or hepatitis. As this attack continues, this inflammation becomes chronic. Over time, this chronic inflammation can cause serious damage to the liver. Specifically, the liver tissue becomes scarred and the liver can gradually fail. This is called cirrhosis .
The good news is that medical treatment can reduce the swelling of the liver and prevent complications from the disease. However, sometimes you may not have any symptoms in the early stages of this disease.
What are the main types of autoimmune hepatitis?
There are two main types of autoimmune hepatitis (AIH). These are distinguished by the presence of different autoantibodies, which our scientists can detect with an antibody test . These different antibodies attack different types of cells in the liver.
Type 1
This is the "classic" type, and it is also the most common type. About 80% of diagnosed patients have this type. It can develop at any age. In type 1 autoimmune hepatitis, antibodies called ASMA (anti-smooth muscle antibodies) attack the smooth muscle cells in the liver. This type 1 condition is sometimes called "lupoid hepatitis" because its symptoms are similar to those of Systemic Lupus Erythematosus . However, the ASMA blood test can help distinguish between the two diseases.
Type 2
Type 2 autoimmune hepatitis is a rarer and more severe form of the disease. It usually appears earlier, in childhood. It can also progress more rapidly than type 1. This type is associated with antibodies called anti-LKM-1 (anti-liver-kidney microsome type 1 antibodies) or anti-LC1 (anti-liver cytosol type 1 antibodies) . Anti-LKM-1 antibodies target a protein in liver cells called cytochrome P450-2D6 (CYP2D6) . Anti-LC1 is a liver antibody specific for type 2 AIH.
How rare is autoimmune hepatitis?
Autoimmune hepatitis is not a very common disease. It is not yet clear how many people have it. According to European studies, the disease affects between 0.010% and 0.025% of the European population. Although it can affect any race or ethnic group, it is slightly more common among Alaska Natives (about 0.043% of that population). It is also more common in women than in men, at a ratio of 4:1.
What are the symptoms?
Not everyone with autoimmune hepatitis will develop symptoms. Sometimes symptoms appear later, after the disease has started to affect the liver's function. This can cause various side effects in the body.
Some common early symptoms include:
- Stomach pain or discomfort.
- Abdominal swelling due to enlarged liver.
- Fatigue .
- Joint pain.
- Skin rashes mean irritation.
- Acne.
When your liver starts to function poorly, bile can build up in your bloodstream. This can cause symptoms like:
- Jaundice ( yellowing of the skin and eyes).
- Dark-colored urine or light-colored stools.
- Itching (Pruritus) .
- Nausea or loss of appetite.
Other delayed side effects may include:
- Spider angiomas (red spots on the skin that look like spider webs) .
- Enlargement of the veins in the anus (varices) .
- Easy bruising and bleeding.
- Loss of monthly menstruation in women.
- Fluid buildup in the abdomen (ascites) or limbs (edema) .
- Confusion, drowsiness, or sleepiness (hepatic encephalopathy) .
What are the causes of autoimmune hepatitis?
Autoimmune diseases occur when your immune system mistakes some of your own cells as a threat. Once the immune system recognizes this "threat," it attacks those cells. This causes chronic inflammation in a specific part of the body. In autoimmune hepatitis, the immune system sends specific antibodies to attack specific types of cells in the liver. This is actually a very complex process.
What is the average age at which this disease begins?
It is not always possible to know exactly when autoimmune hepatitis first started. This is because there are often no symptoms in the early stages. Type 1 AIH is most often diagnosed in early to middle age, between the ages of 15 and 40. However, it can occur at any age. Type 2 AIH usually appears even earlier, in childhood, between the ages of 4 and 14. Even then, severe symptoms of liver disease may be present.
How does autoimmune hepatitis develop?
Why people develop autoimmune diseases is a really complex question. There doesn't seem to be a single cause, but rather a combination of factors.
- Genetic influence: In some cases, your genes may make you more likely to develop certain autoimmune diseases. However, not everyone who has those genes will develop the disease, and not everyone who develops the disease will have those genes.
- Environmental factors: Other non-genetic factors, also called "environmental factors," can contribute to this. These can be toxins or events that put a strain on your immune system. In some susceptible individuals, these factors can cause the immune system to overreact, resulting in a chronic autoimmune disease.
Certain medications and viral infections have been identified as triggers for autoimmune hepatitis. Also, if you already have another autoimmune disease, you are more likely to develop autoimmune hepatitis.
What viruses can trigger autoimmune hepatitis?
You are more likely to develop autoimmune hepatitis if you have a history of these viral infections:
- Viral hepatitis (A, B, C, D or E).
- Mononucleosis (Mononucleosis - Epstein-Barr virus) .
- Measles .
- Herpes .
What drugs can trigger autoimmune hepatitis?
Drug-induced autoimmune hepatitis has been associated with these drugs:
- Nitrofurantoin ( for urinary tract infections).
- Minocycline ( for acne).
- Atorvastatin ( for high cholesterol).
- Isoniazid ( an antibiotic).
What other autoimmune diseases are associated with autoimmune hepatitis?
Some people develop autoimmune hepatitis along with another autoimmune disease that affects their bile ducts. For example:
- Primary biliary cholangitis (PBC) .
- Primary sclerosing cholangitis (PSC) .
This is considered a "variant type" of autoimmune hepatitis.
But in general, if you already have an autoimmune disease, you are more likely to develop another one. It seems that chronic inflammation in one area can trigger inflammation in another area. The chance of developing a second autoimmune disease is about 25%-50%. If autoimmune hepatitis is your first autoimmune disease, you have a similar chance of developing a second one.
Other conditions that are commonly seen with AIH include:
- Graves' disease .
- Celiac disease .
- Inflammatory bowel disease .
- Rheumatoid arthritis.
- Type 1 diabetes.
- Vitiligo ( white spots on the skin).
Is autoimmune hepatitis contagious?
No. Viral hepatitis (such as hepatitis A, B, and C) can be caused by infectious viruses. These infections can be transmitted to others. However, autoimmune hepatitis is not an infection, so it is not contagious to others.
How is autoimmune hepatitis diagnosed?
You may or may not have obvious symptoms of AIH. A doctor will first examine you physically and do some basic tests, such as imaging tests and blood tests. A blood test called a comprehensive metabolic panel can look for evidence of liver disease. This panel includes several liver function tests that measure things like liver enzyme levels and inflammation.
But these indicators are not specific to autoimmune hepatitis. Your doctor will do other blood tests to look for specific viruses and other causes of hepatitis. They will also look for autoantibodies . Once they have ruled out other causes and identified antibodies that are associated with autoimmune hepatitis, they will be ready to confirm the diagnosis. The best way to confirm this is to do a liver biopsy . This involves taking a small piece of tissue from the liver and examining it under a microscope.
What are the treatments for autoimmune hepatitis?
The standard treatment is to start with high doses of corticosteroids to control inflammation and the autoimmune response, then gradually reduce the dose. Prednisone is the most commonly prescribed and best-studied medication for autoimmune hepatitis. It works well for many people, but it can cause side effects. Alternative medications, such as budesonide, appear to have fewer side effects.
Your doctor may prescribe an immunosuppressant called azathioprine along with steroids. Or, they may prescribe it after you finish your steroid treatment. Because azathioprine has fewer side effects than steroids, it works best as a long-term maintenance treatment, to keep your immune system from becoming overactive again. You may need to take it periodically throughout your life.
What are the side effects of the medication?
These treatments can also have some side effects. That's why the doctor will monitor you regularly.
Side effects of long-term use of steroids (Corticosteroids):
- Increased appetite and weight gain.
- Mood disorders such as anxiety and depression.
- Glaucoma ( blurred vision).
- Osteopenia or osteoporosis (weakening of the bones).
- Diabetes .
- High blood pressure .
Side effects of taking immunosuppressants:
- Frequent infections (due to reduced immune system).
- Nausea and vomiting.
- Skin rash (itching).
- Easy bruising and bleeding.
- Impaired kidney function.
- Pancreatitis .
While you're taking these medications, your doctor will monitor you for side effects. If the side effects of your medication are too severe, or if it's not helping you enough, they'll suggest an alternative. Don't be afraid, talk to your doctor about all of this.
How long does it take for the treatment to work?
The goal of the medication is to put the disease into remission . You may need to take the medication for several months to several years to achieve this. During this time, your doctor will check your liver regularly to make sure the treatment is working. Liver function tests will show that your liver enzyme levels are gradually returning to normal. Remission means that all signs and symptoms of the disease have disappeared.
The American Association for the Study of Liver Diseases (AASLD) recommends that you take steroids for at least three years before stopping the medication. After you have been in remission for at least two years, they will consider stopping the immunosuppressants. After stopping the medication, about 50% of people may have a relapse within three months. For others, it may take years, or they may never have a relapse at all.
Some people get some improvement with treatment, but not enough to go into remission. In that case, your doctor will try other medications. Some people don't respond to treatment at all. In that case, the course of the disease continues to get worse. These people may develop complications that require additional treatment. They may eventually need a liver transplant .
Can autoimmune hepatitis be completely cured?
No. It cannot be cured completely. But the disease can be put into remission. This means that the inflammatory process goes away for a while, sometimes for a long time. But after you stop treatment, it can come back. This is called a relapse . Most people who stop taking the medication (about 80%) eventually have the disease come back and have to start taking the medication again. Medications can usually control the disease well, but you may have to take them periodically throughout your life.
What is the average life expectancy with autoimmune hepatitis?
Without treatment, the five-year survival rate is 50%. But with treatment, the 10-year survival rate is 90% and the 20-year survival rate is 70%. Even with treatment, about 15% of people eventually develop cirrhosis, usually after 10 to 20 years. This can happen if treatment fails, if there is an incomplete response to treatment, or if the disease recurs several times. When the disease recurs, it can come back more quickly.
How should I take care of myself while living with autoimmune hepatitis?
This is a very important issue. There are things you can do on your part to control the disease and live a healthy life.
- Don't miss your doctor's appointments. Your doctor will need to monitor your liver for the rest of your life. Even if you've been in remission for a while, the disease can come back without warning or obvious symptoms. Your doctor can monitor the amount of fibrosis (damage before scarring) in your liver using non-invasive methods such as elastography . If you start to experience symptoms again, contact your doctor right away.
- Take care of your diet. A healthy diet is important for anyone with liver disease. Especially with AIH, studies have shown that about 30% of people have symptoms of non-alcoholic fatty liver disease . This means that your body has a tendency to store extra fat in the liver, which is another cause of inflammation. You can counteract this by maintaining a healthy weight and reducing sugar and saturated fats from your diet. This can also help improve your treatment outcomes.
- Protect your immune system. Both liver disease and immunosuppressant drugs weaken your immune system. That means you need to take good care of yourself to keep yourself from getting sick. Your doctor may recommend certain vitamin supplements and vaccines to protect you from infections. Don't take any supplements that your doctor hasn't approved.
- Avoid alcohol. Alcohol consumption weakens your immune system and damages your liver.
Autoimmune hepatitis is a serious disease, but many people respond well to treatment. The disease can go into remission, almost completely disappearing for a long time. If it comes back, the same treatment may be used again. Treatment can have side effects, but by taking care of your diet and immune system, you can live a relatively normal life. If treatment doesn't work, a liver transplant is an option.
Things to remember from this article (Take-Home Message)
Okay, so, from what we've talked about, these are the most important things you need to remember:
- Autoimmune hepatitis is a chronic disease in which your own immune system attacks your liver.
- This is not a contagious disease.
- There may be no symptoms in the early stages, but symptoms such as fatigue, stomach discomfort, and jaundice may appear.
- Blood tests and a liver biopsy may be necessary for an accurate diagnosis.
- Treatment (steroids, immunosuppressants) can put the disease into remission. However, there is no complete cure, and relapse is possible.
- Treatments can have side effects, so medical supervision is essential.
- A healthy lifestyle (good diet, avoiding alcohol, following medical advice) is very important in managing the disease.
- Don't be afraid. You can live a good life even with this condition. Discuss everything with your doctor and follow his advice.
If you have any further questions about this, be sure to ask your doctor. Wishing you a speedy recovery!
` Liver disease, autoimmune hepatitis, immune system, liver inflammation, cirrhosis, autoimmune diseases, liver treatment
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