Chronic Autoimmune Hepatitis
"There is a treatment capable of improving the symptoms, normalizing the analytical alterations, and, most importantly, stopping or slowing the evolution of the disease".
DR. JOSÉ IGNACIO HERRERO SANTOS
SPECIALIST. HEPATOLOGY UNIT
Chronic autoimmune hepatitis is a chronic disease characterized by inflammation of the liver, which is produced by the abnormal reaction of the immune system against the normal structures of the liver itself.
Three variants of the disease have been described, each with a somewhat different pattern in testing and a different, more aggressive course in chronic autoimmune hepatitis type II.
The prognosis of the disease has changed significantly with the available treatments. Between two and three quarters of patients normalize the liver function tests. Most patients need to maintain medication, even at low doses, in order to control the disease.
Untreated chronic autoimmune hepatitis progresses to liver cirrhosis. This is a disease that is often aggressive, mainly in the type II variant and also in people who are older at the time the disease begins, so that this evolution towards cirrhosis can occur in very few years.
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What are the symptoms of chronic autoimmune hepatitis?
The symptoms produced by chronic autoimmune hepatitis are highly variable. Most of the patients are asymptomatic, and the disease is discovered by the analytical alterations found in a routine revision or made for another reason.
In a quarter of the patients there may be symptoms of acute hepatitis, with fever, malaise, nausea, and progressive jaundice.
It is common the existence of an increase in the size of the liver, called hepatomegaly, and, when there is advanced disease, other secondary symptoms may appear, such as an increase in the size of the spleen, ascites and others. In young women it is not uncommon the appearance of amenorrhea (absence of menstruation), facial acne, hirsutism and stretch marks on the skin.
In a small group of patients, autoimmune hepatitis, especially autoimmune hepatitis type II, can occur along with other diseases of autoimmune origin such as inflammatory bowel diseases, endocrine diseases (thyroiditis) and rheumatic diseases (rheumatoid arthritis, Sjogren's syndrome and systemic sclerosis).
What are the most common symptoms?
- General malaise.
Do you have any of these symptoms?
You may have chronic autoimmune hepatitis
What are the causes of chronic self-immune hepatitis?
The cause of this type of hepatitis is not known.
As with other autoimmune diseases, there is probably a genetic predisposition, to which an acquired trigger must be added that is not known. In this sense, this disease is associated with some genes, such as the histocompatibility antigens HLA-B8 and HLA-DR3.
Who can be affected?
- This is a rare disease, as it accounts for about 10% of all chronic hepatitis.
- It affects women more often than men.
- In terms of age, there are two periods in which it is more common, one in adolescents or young adults, between 15 and 25 years, and another in adults in average age, between 45 and 60 years.
How is chronic autoimmune hepatitis diagnosed?
The diagnosis of chronic autoimmune hepatitis begins with the detection of elevated blood levels of transaminases, as occurs in all types of hepatitis.
From there, the analytical study in this disease shows the existence of autoantibodies, that is, antibodies against own structures, with different patterns in the three different forms of the disease. 60% of the patients present ANA (antinuclear antibodies) and smooth antimuscle antibodies (AML or SMA). More than 80% of the cases have an increase of gamma globulins in the blood.
A liver biopsy is required to confirm the diagnosis. Other diseases that can produce chronic hepatitis must be ruled out.
How is chronic autoimmune hepatitis treated?
Since it is an illness of unknown cause, there is no curative treatment. However, as the mechanisms that damage the liver in this disease, mediated by the immune system, are increasingly known, there is a treatment that improves the symptoms, normalizes the analytical alterations and, most importantly, stops or slows down its evolution.
The treatment is based on immunosuppressive drugs. Initially corticosteroids are used, especially prednisone, which allows a rapid improvement in 90% of patients. In order to improve the response and also achieve the use of lower doses of corticoids, other immunosuppressants can be added to the treatment, such as azathioprine, cyclosporine, tacrolimus or mycophenolate.
In 20% of the cases, after a course of immunosuppressive treatment, which usually lasts between 3 and 6 years, it is possible to stop the medication definitively. In all patients it is necessary to perform a periodic follow-up to monitor the evolution of the disease.
In patients with advanced disease, who already have liver cirrhosis, liver transplantation may be indicated.
Where do we treat it?
IN NAVARRE AND MADRID
The Hepatology Unit
of the Clínica Universidad de Navarra
We are pioneers in the application of gene therapy in the treatment of liver tumors and hereditary metabolic diseases, and we have extensive experience in the diagnosis and treatment of viral hepatitis and in the treatment of liver cancer using radioembolization systems with Ytrium-90 microspheres.
The Clinic is at the forefront in Spain in performing liver transplantation between living people.
Diseases we treat
Why at the Clinica?
- Highly specialized team of professionals with more than 25 years of experience.
- Nursing team specialized in hepatic patients.
- Important research activity on the molecular mechanisms that cause some of these diseases.