It is not viruses as in the hepatitis forms A, B or C, which cause this rare hepatitis, but it is, as with other autoimmune diseases also, a dysregulation of the body's defense system. Autoimmune hepatitis (AIH) affects women in about 80% of cases and occurs more often in middle age, but can generally begin at any age, even in childhood.
How does an autoimmune hepatitis develop?
How autoimmune hepatitis develops could not be clarified until today. It is believed that environmental factors, toxins or drugs can act as a trigger, but above all previous virus or bacterial infections. In addition, probably a genetic disposition plays a role in the development. In the course of disease development, the immune system loses its tolerance to its own liver tissue and the liver cells are destroyed by the body's own T lymphocytes.
Autoimmune hepatitis: symptoms are not very characteristic
The symptoms are usually uncharacteristic and may be limited to indefinite fatigue, decreased performance, nausea and mild yellowing of the skin. Also, pain in the right upper abdomen and unclear temperature increase are possible symptoms, but often are not properly evaluated.
About 30% to 50% of those affected suffer from other comorbidities in which the immune system also attacks their own organs, such as rheumatoid arthritis, white spot disease (vitiligo), autoimmune thyroiditis (inflammation of the thyroid) or colitis ulcerative colitis.
Overall, the signs of the disease can be very discreet and barely discernible, but it can also develop into a rapidly progressing liver inflammation up to liver failure. Autoimmune hepatitis is the cause of chronic hepatitis in 10 to 20% of cases.
Autoimmune hepatitis: diagnosis and therapy
It is important to make the diagnosis as early as possible, as a rapid start of therapy is crucial for the further course. For the diagnosis, first laboratory chemical investigations are made, in which an infection by viruses is excluded. In addition to an increase in transaminases and immunoglobulins of the IgG type, the most important clues to be found in 75% are the autoantibodies directed against one's own liver tissue. To ensure the diagnosis, a tissue sample is taken from the liver for the histological examination under local anesthesia.
With timely diagnosis, the condition almost always responds very well to immunosuppressive therapy, which dampens the activity of the immune system. The prospects for healing are then very good. If left untreated, liver cirrhosis will develop in just a few years, and life expectancy will be greatly reduced.
Autoimmune hepatitis: treatment needed in the long term
Two options are available for therapy: either only treatment with the cortisone preparation prednisolone or combination treatment with prednisolone and azathioprine. In patients with an existing desire for children, the sole cortisone treatment is usually chosen, otherwise the combination is given preference. With the combination, the cortisone dose can be kept lower and the side effects can be significantly reduced.
Due to the need for long-term treatment, side effects such as osteoporosis, stomach ulcers, high blood pressure, steroid diabetes, full moon and acne, caused by cortisone, should be minimized. It is first started with a higher dose and then reduced to the lowest possible maintenance dose. The recent cortisone drug budesonide appears to cause fewer side effects than prednisolone.
A treatment of at least 2 years is recommended before trying to eliminate the medication. If the laboratory values rise again, the drugs must be taken again over several years. About 13% of those affected do not respond to the therapy. They may need a liver transplant.