Clinical Utility Of Liver Kidney Microsomal/liver Microsomal Autoantibodies
As outlined above antimicrosomal autoantibodies exhibit a broad range of associations . The clinically most relevant are discussed below.
Autoimmune hepatitis type 2 -associated microsomal autoantibodies
AIH can be serology subdivided into three types, which are characterized by antinuclear autoantibodies and smooth muscle autoantibodies , by LKM-1 autoantibodies directed against CYP2D6 , and by soluble liver antigen autoantibodies . According to the simplified diagnostic AIH criteria published in 2008 and the American Association for the Study of Liver Diseases practice guideline published in 2010, LKM autoantibodies belong to the conventional repertoire of diagnostic autoantibodies in AIH. In 10% of AIH-2 patients, LKM-3 autoantibodies against UGT1A are additionally present . In AIH-2 patients, additional organ-specific autoantibodies can be detectable, which include antithyroid, antiparietal cell, and anti-Langerhans cell autoantibodies. A number of extrahepatic immune-mediated syndromes can be encountered including diabetes, vitiligo, and autoimmune thyroid disease. Serum immunoglobulin G levels are elevated. AIH-2 is a rare serologic subtype of AIH affecting 20% of AIH patients in Europe and 4% in the US. There is a female predominance as generally observed for AIH. The age maximum is around 10 years, but AIH-2 is also observed in adults, especially in Europe. AIH-2 carries a higher risk of progression to cirrhosis and of a fulminant course.
Early Symptoms Of A Flare Up You Might Not Recognize
We all know the hallmark signs that we are about to experience a flare up of our autoimmune symptoms. You cant ignore the debilitating fatigue, unusual rashes, and fevers, or achy joints and muscles that announce we are under serious attack by our immune system. But did you realize that our body offers us subtle clues our immune system is gearing up for a fight long before the obvious symptoms kick in? If we can become adept at listening to our body we can offer it the extra rest and TLC it needs to prepare to win a flare up battle. Here are ten of the early symptoms of a flare-up that you might not recognize.
What Are Autoimmune Diseases
Your immune system protects you from disease and infection by attacking germs that get into your body, such as viruses and bacteria. Your immune system can tell that the germs aren’t part of you, so it destroys them. If you have an autoimmune disease, your immune system attacks the healthy cells of your organs and tissues by mistake.
There are more than 80 types of autoimmune diseases. They can affect almost any part of your body. For example, alopecia areata is an autoimmune disease of the skin that causes hair loss. Autoimmune hepatitis affects the liver. In type 1 diabetes, the immune system attacks the pancreas. And in rheumatoid arthritis, the immune system can attack many parts of the body, including the joints, lungs, and eyes.
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Potential Outcomes Of Immunosuppressant Therapy
The goal of treatment is disease remission. In remission, patients experience the improvement of symptoms, the normalization of abnormal liver chemistries and gamma globulin levels, and the reduction or elimination of inflammatory activity on liver biopsy.
Most patients who embark on a course of immunosuppressant therapy respond well initially. More than 90% of adults started on corticosteroid treatment experience improvements in liver chemistries and gamma globulin levels within 2 weeks.
Remission, if it is to be achieved, typically requires 18-24 months of immunosuppressant therapy. Remission can be achieved in about 65% of patients within 18 months and 80% of patients within 3 years. Once a drug-induced remission is achieved, an attempt should be made to withdraw immunosuppression. However, a sustained remission after total drug withdrawal is seen in 13% of patients at 5 years. Patients who relapse need to restart long-term immunosuppressant therapy in an effort to normalize their biochemical abnormalities and to delay the progression of liver disease. Many such patients are maintained on chronic maintenance therapy with azathioprine.
About 13% of patients experience an incomplete response to treatment, without worsening of their condition. Most incomplete responders need long-term immunosuppression in an attempt to stabilize levels of aspartate transaminase and alanine aminotransferase andby extensionprevent disease progression.
References
What Are Some Things I Can Do To Feel Better
If you are living with an autoimmune disease, there are things you can do each day to feel better:
You have some power to lessen your pain! Try using imagery for 15 minutes, two or three times each day.
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Autoimmune Disease And Your Health
Having lupus, rheumatoid arthritis or psoriatic arthritis raises your risk for heart disease. While taking steps to reduce heart disease is always a good idea, it is even more essential if you have one of these conditions. Talk to your doctor about what you can do to keep your heart healthy and strong. For example, keeping your blood pressure and cholesterol levels within healthy ranges, eating a nutritious diet and exercising regularly can be lifesaving.
These steps can also help reduce the symptoms of autoimmune disease. Orbai admits that making time for healthy living can be hard, given womens fast-paced lives, but she insists that finding the balance is key to living with autoimmune disease.
Its something thats going to involve commitment, and sometimes its going to be tough, she says. But learning to listen to your body and being smart about what triggers your disease is important. Its something you do for yourself.
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Autoimmune Hepatitis & How It Is Diagnosed
Falk: What on earth is autoimmune hepatitis? What do those words really mean?
Darling: Autoimmune hepatitis is a chronic liver disease. It can affect any aged patient, any ethnicity, it can affect either sex, usually has a female-to-male predominance of about 3:1. Hepatitis just means inflammation of the liver.
Falk: Remind me again, what does the liver do?
Darling: The liver does a lot of important things. For one, it metabolizes nutrients from the gut, it makes bile which helps you digest fats, it makes a lot of important proteins, specificallyall of your clotting factors except for one, and proteins that help fluids stay in the right spaces. It also detoxifies certain drugs or medications.
Falk: When you inflame a liver, just like when you inflame any other organ, the suffix is -it is the liver is the hepatic system, so hepatitis which is inflammation of the liver from any number of causes.
Darling: Absolutely. The liver is made up of liver cells or hepatocytes, and its made up of small and large bile ducts, and for the most part it implies that this is inflammation of the liver cells themselves, the hepatocytes. It is usually manifested as elevated liver enzymes, so AST, ALTthese are blood tests and it is reflective of turnover of liver cells.
Falk: The liver can be affected by a number of factors. One can get hepatitis from alcohol, one can get hepatitis from a number of drugs, one can get hepatitis from certain viruses. Whats the most common of those entities?
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Autoimmune Disease Can Be A Silent Killer
Many autoimmune diseases start with small symptoms that can insidiously grow and morph into more small symptoms. This can happen for decades before the problems have done enough damage to send you into a doctors office to get a definitive diagnosis. That means you could have years of accumulated inflammatory damage before learning that your body has been silently attacking itself. The following video breaks down that top 7 symptoms of autoimmune disease that often go missed leading to years of unnecessary suffering
Autoimmune Hepatitis And Alcohol
Autoimmune hepatitis is not caused by alcohol consumption. Researchers believe those with AIH may have a genetic disposition to the condition which is triggered by environmental factors. Those with other autoimmune diseases are also more likely to be diagnosed with AIH.
For those living with autoimmune hepatitis, it’s important to talk with your doctor about recommendations around alcohol consumption. High alcohol consumption can worsen liver damage in several liver diseases, such as hepatitis C and non-alcoholic fatty liver disease. Less research has been done on low or moderate alcohol consumption, or on the impact of high alcohol consumption on rare liver diseases, including autoimmune hepatitis .
Low-to-moderate alcohol consumption, considered in most countries to be a maximum of two drinks per day for women and three drinks per day for men, is not associated with an increased risk for liver disease. Those with existing liver diseases, however, should talk with their doctors about what a safe level of alcohol consumption may be for them, also taking into account how their current medications may interact with alcohol. The Liver Foundation recommends reducing alcohol consumption to one drink per day for women and two drinks per day for men for those living with liver disease.
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Common Autoimmune Disease Symptoms
Despite the varying types of autoimmune disease, many of them share similar symptoms. Common symptoms of autoimmune disease include:
- Fatigue
- Abdominal pain or digestive issues
- Recurring fever
- Swollen glands
Many women say its hard to get diagnosed, something that Orbai agrees with. Its not black or white, she says. Theres usually no single test to diagnose autoimmune disease. You have to have certain symptoms combined with specific blood markers and in some cases, even a tissue biopsy. Its not just one factor.
Diagnosis can also be difficult because these symptoms can come from other common conditions. Orbai says women should seek treatment when they notice new symptoms.
If youve been healthy and suddenly you feel fatigue or joint stiffness, dont downplay that, she says. Telling your doctor helps him or her to look closer at your symptoms and run tests to either identify or rule out autoimmune disease.
Autoimmune Disease: Why Is My Immune System Attacking Itself?
Autoimmune disease affects 23.5 million Americans, and nearly 80 percent of those are women. If you’re one of the millions of women affected by this group of diseases, which includes lupus, rheumatoid arthritis and thyroid disease, you may be wondering why your immune system is attacking itself.
Management Of Autoimmune Hepatitis
Early data from trials of patients with what was then referred to variably as lupoid hepatitis, chronic active hepatitis or HBsAg negative chronic active hepatitis, highlight the poor prognosis of the condition without treatment. A follow-up study of patients presenting in the mid-1960s who were treated with steroids showed a 10-year survival of 63% in the treatment group compared with 27% in the control group with a median survival of 12.2 vs. 3.3 years. Therapy prolongs life, and prednisolone is first line therapy for inducing remission of disease while azathioprine is first line for maintenance of remission., Failure to use azathioprine is associated with poor outcomes in AIH.
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Steroids And Induction Of Remission
Guidelines for monitoring patients on long-term corticosteroids should be followed and, owing to the risk of steroid-related bone disease, patients should take calcium and vitamin D supplementation, after usually having a baseline bone density scan. However, the value of bone density scans in young adults is not clear, nor is the frequency with which scans should be repeated, although commonly repeat bone density measurement occurs at three yearly intervals. Of more relevance is individualized patient risk assessment and discussion of bone health with appropriate osteoporosis experts. Most authorities recommend 10001200 mg of calcium and 8001000 international units of vitamin D daily. Blood glucose should also be monitored regularly to look for steroid precipitated diabetes mellitus. After 12 months of treatment with steroids, patients should be considered for screening for cataracts and glaucoma.
When To See A Healthcare Provider
If you’re worried you may be experiencing symptoms of an autoimmune condition, be sure to see a healthcare provider for a comprehensive evaluation, which will include a thorough physical examination, blood tests, and possibly imaging tests.
If your primary care or family healthcare provider suspects an autoimmune process, you will likely be referred to a specialist, such as a rheumatologist , an endocrinologist , or a gastroenterologist .
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Dos And Donts In Managing Autoimmune Hepatitis:
- DO remember that monitoring of your condition is important. Report any new symptoms to your health care provider promptly.
- DO call your health care provider if you notice skin color changes, side effects from medicines, joint pains, or abdominal swelling.
- DONT ignore drug side effects, such as weight gain, anxiety, confusion, thinning of bones , thinning of the hair and skin, diabetes, high blood pressure, and cataracts.
- DONT use alcohol. It may further damage your liver.
- National Institute of Diabetes and Digestive and Kidney Disease
What Are The Symptoms Of Autoimmune Diseases
The symptoms of an autoimmune disease depend on the part of your body that’s affected. Many types of autoimmune diseases cause redness, swelling, heat, and pain, which are the signs and symptoms of inflammation. But other illnesses can cause the same symptoms.
The symptoms of autoimmune diseases can come and go. During a flare-up, your symptoms may get severe for a while. Later on, you may have a remission, which means that your symptoms get better or disappear for a period of time.
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Types Of Autoimmune Hepatitis
There are two types of AIH based on serum tests:
- Type I is more common, tends to affect young women, and is associated with other autoimmune diseases. This is the most common form of AIH in the United States.
- Type II primarily affects girls between the ages of 2 and 14.
While AIH generally occurs in adolescence or early adulthood, it can develop at any age.
Symptoms of AIH range from mild to severe. In the early stages, you may have no symptoms, but in later stages, symptoms can appear suddenly. They may also slowly develop over time.
AIH symptoms include:
Blood tests can also measure the amount of immunoglobulin G antibodies in your blood. IgG antibodies help the body fight infection and inflammation.
A liver biopsy may sometimes be necessary to diagnose AIH. It can reveal the type and severity of your liver damage and inflammation. The procedure involves removing a small piece of your liver tissue with a long needle and sending it to a laboratory for testing.
Treatment can slow down, stop, and sometimes reverse liver damage. Approximately 65 to 80 percent of people with AIH will go into remission. However, remission can take up to three years.
How Is Autoimmune Hepatitis Treated
The goal of treatment is to stop the bodys attack on itself by suppressing the immune system. This is accomplished with a medicine called prednisone, a type of steroid. Often times, a second drug, azathioprine is also used. Treatment starts with a high dose of prednisone. When symptoms improve, the dosage is lowered and azathioprine may be added. In most cases, autoimmune hepatitis can be controlled but not cured. That is why most patients will need to stay on the medicine for years, and sometimes for life. Unfortunately, long-term use of steroid can cause serious side effects including diabetes, osteoporosis, high blood pressure, glaucoma, weight gain and decreased resistance to infection. Other medications may be needed to control these side effects.
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I Want To Have A Baby Does Having An Autoimmune Disease Affect Pregnancy
Women with autoimmune diseases can safely have children. But there could be some risks for the mother or baby, depending on the disease and how severe it is. For instance, pregnant women with lupus have a higher risk of preterm birth and stillbirth. Pregnant women with myasthenia gravis might have symptoms that lead to trouble breathing during pregnancy. For some women, symptoms tend to improve during pregnancy, while others find their symptoms tend to flare up. Also, some medicines used to treat autoimmune diseases might not be safe to use during pregnancy.
If you want to have a baby, talk to your doctor before you start trying to get pregnant. Your doctor might suggest that you wait until your disease is in remission or suggest a change in medicines before you start trying. You also might need to see a doctor who cares for women with high-risk pregnancies.
Some women with autoimmune diseases may have problems getting pregnant. This can happen for many reasons. Tests can tell if fertility problems are caused by an autoimmune disease or an unrelated reason. Fertility treatments are able to help some women with autoimmune disease become pregnant.
An Ordinarily Healthy Person Who Suddenly Develops Symptoms
Falk: Tell me a little bit about you, and what you were able to do prior to your illness.
Kristen: I am 35 years old and Im married, I have three children and I live in Durham, North Carolina. Before I got sick, I led a very healthy, very active lifestyle. I was running half marathons and doing a lot of long distance running and I was competing in local races and doing very well for myself.
Falk: At the same time, youre a mom, youre an athlete, youre employed and have a full time busy job.
Kristen: Yes.
Falk: So before this illness occurred, you were an incredibly productive 35-year-old mom.
Kristen: Yes, and I had zero history of any kind of health problem.
Falk: When you became ill, the illness came out of the blue, you would have had the typical cold or other kind of community-acquired illnesses of otherwise healthy individuals. What were about to describe is really a different constellation of things that were bothering you. What were those? How did it start?
Kristen: I think I noticed things starting when I couldnt run like I normally could. It felt painful to run, which was a really new feeling for me.
Falk: Your joints were bothering you?
Kristen: No, I was getting out of breath and it just felt really hard to do, and so I basically slowly stopped running. It was more than just in my lungs, my body was tired and I was having pains. I started having more pains even when I wasnt runningI developed pains in my chest.
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