Autoimmune hepatitis is an immune disease that is found predominantly in women, characterized by chronic liver damage and systemic manifestations. Autoimmune hepatitis is a relatively rare disease, given the fact that the diagnosis is often missed. Generally the discovery of autoimmune hepatitis is usually in a patient with chronic liver pain, marked hypergammaglobulinemia with fever, arthralgia and negative viral markers. In these cases, immunological markers such as ANA, LKM 1, SMA are positive.
The exact cause of autoimmune hepatitis is not know, but it is assumed that due to a genetic predisposition or exogenous factors, there is a loss of immune tolerance to the liver tissue, transforming it from self to non-self. Among the exogenous factors, hepatitis C often trigger an autoimmune hepatitis, rarely hepatitis B can determine this disease. Some drugs can trigger autoimmune hepatitis (alpha methyldopa). Immune response target is a membrane protein called liver specific protein, which by some mechanism it is turning from self, into non-self and will become cytotoxic.
Symptoms are generally noisier than in chronic hepatitis B, but the symptoms may also be absent.
The onset of autoimmune hepatitis occurs in young women or over 40 years old and it is characterized by fatigue, asthenia, fever, arthralgia.
Immune manifestations are variable and consist of:
- Autoimmune thyroiditis;
- Autoimmune hemolytic anemia;
- Rheumatoid arthritis;
- Autoimmune glomerulonephritis;
- Thrombocytopenic purpura.
Laboratory tests show signs of liver damage and immune signs:
Signs of liver damage are:
- Elevated transaminases (AST, ALT);
- Slightly decreased serum albumin;
- Normal bilirubin;
- Gammaglobulins greatly increased.
Specific immune changes in autoimmune hepatitis are:
- Antinuclear Antibodies (ANA);
- Smoth Muscle Antibodies (SMA);
- Liver Kidney Microsomal Antibodies (LKM 1);
- Liver Specific Protein Antibodies (LSP).
Autoimmune hepatitis is divided into several types, depending on the antibodies that appear as follows:
- Autoimmune hepatitis type 1: is characterized by the presence of ANA and SMA, this type represent many of the cases of autoimmune hepatitis, around 70% . It is often associated with other autoimmune disease and often progresses to cirrhosis.
- Autoimmune hepatitis type 2: characterized by presence LKM 1. This type of autoimmune hepatitis occurs in both sexes, often in childhood. This type is associated with infection with hepatitis C and will progress to cirrhosis in 80% of cases.
- Autoimmune hepatitis type 3: a very rare form and is associated with the presence of LSP.
Treatment of autoimmune hepatitis is based on immunosuppressive medication and focused on the following:
- use of immunosuppressive and anti-inflammatory drugs;
- preventing and treating side effects of therapy;
- autoimmune hepatitis prevention and treatment of complications, including autoimmune cirrhosis.
Basic medication is represented by corticosteroids, which are used for a period of approximately six months. May be associated with immunosuppressive drugs such as azathioprine. This combination is recommended in terms of postmenopausal osteoporosis, diabetes mellitus, obesity, hypertension.
The occurrence of relapse after stopping therapy, makes it to be used for life.