Autoimmune hepatitis What we need to know

Autoimmune hepatitis causes chronic inflammation of the liver, although the cause is not an infectious agent or alcohol, but an autoaggressive process. The disease cannot be cured, but remission can be achieved with treatment.

Autoimmune hepatitis is a very rare condition, and epidemiological data are uncertain, although it is statistically believed that this disease occurs in 0.1-025% of the European population. The ratio between the incidence of women and men is 4:1.

Autoimmune chronic inflammatory process seriously damages liver cells, which over time undergo fibrotic degeneration and liver cirrhosis develops.

There are 2 types of the disease, which are characterized by the presence of different types of auto-antibodies. Different types of autoantibodies damage different types of liver cells.

Type 1

Autoantibodies of this class are common and occur in 80% of diagnosed cases. The onset of the disease is possible at any age, although it occurs more often in women aged 15-40. In type 1 of the disease, anti-smooth muscle antibodies (ASMA) develop. This type of disease is also called "lupoid" hepatitis, because the clinical signs are similar to systemic lupus erythematosus. The diagnostic criterion is the detection of ASMA antibodies in blood serum.

Type 2

Autoimmune hepatitis type 2 is rarer. The disease begins in childhood and progresses more rapidly than type 1. In this form, liver-kidney microsomal type 1 autoantibodies (anti-LKM-1) and/or liver cytosolic protein autoantibodies (anti-LC1) are detected. These antibodies are specific for type 2 autoimmune disease, more common in girls aged 2-14 years.

reasons

The exact cause of autoimmune diseases is unknown. There are many factors involved. In some cases, there are genes that increase susceptibility to autoimmune diseases. However, not everyone with these genes will develop an autoimmune disease, and vice versa. Non-genetic - environmental factors should also be taken into account, which in susceptible individuals lead to the development of an immune response and are often the trigger mechanism of the disease.

Autoimmune hepatitis can be triggered by specific medications, viral infections, and the presence of other autoimmune diseases.

Viruses that have the ability to cause an autoimmune reaction:

• A, B, C, D, E hepatitis viruses
• Epstein-Barr virus (mononucleosis)
• Measles virus
• Herpesviruses

Medicines that can provoke an autoimmune process:

• Nitrofurantoin (urinary tract antibacterial)
• Minocycline (acne medication)
• atorvastatin (statin)
• isoniazid (antibiotic)

Some people develop autoimmune hepatitis in the presence of other autoimmune diseases, such as:

• Primary biliary cholangitis
• Primary sclerosing cholangitis

In general, a pre-existing autoimmune process and a focus of chronic inflammation increase the risk of developing another autoimmune disease by 25-50%.

Along with autoimmune hepatitis, there may be other autoaggressive processes:

• Graves' disease
• Celiac disease
• Inflammatory bowel disease
• Rheumatoid arthritis
• Type 1 diabetes
• Vitiligo

Symptoms

The disease is sometimes asymptomatic. Symptoms develop later, against the background of liver failure and complications.

Early symptoms include:

• Abdominal pain or discomfort
• Liver enlargement
• An increase in the size of the abdomen
• common weakness
• Pain in the joints
• Rash on the skin
• Acne

Later, when liver functions are gradually destroyed, bilirubin and liver enzymes accumulate in the blood, which causes the following symptoms:

• Jaundice
• Darkening of urine
• Itchy skin
• Nausea
• Ingratitude

Later symptoms also include:

• A network of angiomas on the skin
• Varicose veins of the esophagus
• Bleeding tendency
• In women - cycle disorder
• Ascites - accumulation of fluid in the abdominal cavity
• Swelling of the limbs
• Dizziness
• Disorientation, disorders of consciousness

Diagnosis

Since the disease is often asymptomatic, the diagnostics is sometimes delayed.

• Functional samples of the liver
• lipid profile
• markers of inflammation
• Serological tests
• Hepatitis virus tests
• Imaging studies: ultrasound, CT, MRI.
• Liver biopsy

Treatment

To reduce the autoaggressive inflammatory process, corticosteroids and immunosuppressants are prescribed, the dosage and duration of treatment are determined by the attending physician.

Since steroid therapy and immunosuppressive treatment in autoimmune diseases are permanent or periodic and continue throughout life, these drugs have side effects.

Side effects of steroids:

• Weight gain
• Sudden mood swings (anxiety-depression)
• Glaucoma
• Osteopenia and osteoporosis
• diabetes
• arterial hypertension

Side effects of immunosuppressants:

• Frequent infections
• Nausea-vomiting
• Skin rash
• Bleeding tendency
• Kidney dysfunction
• Pancreatitis

The duration of treatment is individual and depends on many factors (age of disease development, severity of course, degree of liver dysfunction, presence of other diseases, including autoimmune diseases, titer of autoantibodies, etc.). The goal of treatment is to put the disease into remission, which means the reversal of symptoms. When the treatment does not give any result, the issue of liver transplantation arises.

forecast

Autoimmune hepatitis is not cured, which means that the inflammatory process, reduced in the background of treatment, may be activated again sooner or later. It is necessary to take medication continuously or periodically throughout life.

"Synevo" offers laboratory tests for diagnosing autoimmune hepatitis and monitoring the functional state of the liver:

The time for issuing research results is not absolute, it can change taking into account various factors

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