Can You Reverse Autoimmune Hepatitis?
It is important that all patients with autoimmune hepatitis are evaluated by a doctor who specializes in liver diseases. They should have follow-up with analysis, and ultrasound if appropriate. They must lead a healthy life. Healing or reversing the autoimmune hepatitis is rare. More than 70% of patients need immunosuppressive treatment for life.
Autoimmune hepatitis is a liver disease originated by a dysfunction of the immune system that causes it to attack and destroy the liver cells. In other words, the defense mechanisms of the body react against the liver cells.
This is a rare disease, it usually presents as a severe acute hepatitis, chronic hepatitis or cirrhosis. This hepatitis becomes chronic and cannot be prevented.
The causes are not known, but it is thought that there may be a genetic predisposition, since it often affects people with relatives who have autoimmune diseases. It has been suggested that some toxic or microbial environmental agents could be the precipitating factors of the disease onset. It has been implicated viruses that cause different diseases such as measles or kissing disease, as well as the hepatitis A virus. Also some drugs, including some that are used to reduce cholesterol such as pravastatin and atorvastatin. The action of some herbal products has also been postulated. However, there is no sure evidence that they are responsible for the disease.
Autoimmune hepatitis occurs mainly in girls and young women; it affects the female sex in 70% of cases. The disease can begin at any age, but is more frequent in adolescents or young adults. The most common symptoms of autoimmune hepatitis are fatigue, inaccurate abdominal discomfort, joint pain, pruritus (itching in the body), jaundice (yellowish coloration of skin and mucous), hepatomegaly (enlarged liver) and spider veins (venous dilatations) in the skin.
When patients have liver cirrhosis, they may also have ascites (fluid in the abdominal cavity) and hepatic encephalopathy (state of mental confusion).
The diagnosis is based on clinical and analytical data and also on liver biopsy in which there are generally alterations very suggestive of the disease. For diagnosing the disease it is vital the presence of antinuclear antibodies, such as anti-smooth muscle or Liver kidney microsome type 1 (LKM-1). These last antibodies occur in autoimmune hepatitis type 2, which is very rare, predominantly in children and with the need to maintain immunosuppressive treatment almost indefinitely. There is also an increase in gamma globulins.
The majority of patients respond well to immunosuppressive therapy. When this happens, the survival of the disease is very good, and depends on the severity of the disease at the time of diagnosis. Patients who already have cirrhosis when the disease is diagnosed have a worse prognosis. Survival at 10 years of patients without treatment is approximately 10%.
The goal of the treatment of autoimmune hepatitis is to cure or control the disease. Between two and three quarters of patients tend to normalize liver function tests.
The treatment of autoimmune hepatitis consists in the administration of immunosuppressive drugs either with prednisone or in combination with azathioprine. Medical treatment has shown to be effective on the disease symptoms, liver function tests and increases survival in the majority of patients. Normally, treatment with 60 mg/day of prednisone or at a dose of 30 mg/day of prednisone a day along with 50 to 100 mg/day of azathioprine is started.
This treatment should be continued for several weeks until the disease is remitted, at which time the doses of prednisone are progressively reduced to the minimum necessary to keep the activity of the process under control. The suspension of treatment carries the risk of relapse, which can be difficult to control. The drawback of using prednisone at high doses for a long time is the appearance of serious side effects, such as high blood pressure, diabetes, bone loss and cataracts. Low doses of prednisone are often used in combination with azathioprine. Not all patients with autoimmune hepatitis respond to treatment with prednisone. In these cases other drugs (budesonide, cyclosporine, tacrolimus or mycophenolate) are used.