What To Expect From Your Doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:
- When did you first begin experiencing symptoms?
- Have your symptoms been continuous, or occasional?
- How severe are your symptoms?
- Does anything seem to improve or worsen your symptoms?
- Are you taking any medicines or treatments for your symptoms?
- Do you have a family history of liver disease?
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Types Of Autoimmune Hepatitis
There are two types of autoimmune hepatitis. Type 1 autoimmune hepatitis is the most common kind in the United States, while type 2 is more commonly seen in Europe and tends to be a more severe disease. The two forms of autoimmune hepatitis are characterized by the presence of different types of antibodies, proteins released by the immune system to fight bacteria and viruses. They are:
- Type 1 is the most common, accounting for 96% of autoimmune hepatitis cases in North America. It usually affects young women who have other autoimmune conditions, such as type 1 diabetes, thyroiditis, and celiac disease. People with this type of autoimmune hepatitis have antinuclear antibodies and antismooth muscle antibody .
- Type 2 is less common in North America, making up only 4% of all autoimmune hepatitis cases. It typically affects females ages 214. Individuals with this type of autoimmune hepatitis have anti-liver kidney microsomal antibody type 1 and/or anti-liver cytosol type 1 autoantibodies.
Do Medicines Used To Treat Autoimmune Hepatitis Have Side Effects
Medicines for autoimmune hepatitis can cause side effects. Your doctor will monitor any side effects and help you manage them while you take these medicines. Your doctor also may adjust the doses or change the medicines you take. You may need to stop taking corticosteroids or azathioprine if you have severe side effects.
Side effects of corticosteroids may include
- changes in how you look, which may include weight gain, a fuller face, acne, or more facial hair
- liver damage
- pancreatitis
Corticosteroids and azathioprine suppress, or decrease the activity of, your immune system, which increases your risk for infections. These medicines can also increase your risk of developing cancers, especially skin cancers.
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What Are The Side Effects Of Prednisone And Azathioprine
Both prednisone and azathioprine have side effects. Because high doses of prednisone are often needed to control autoimmune hepatitis, managing side effects is very important. However, most side effects appear only after a long period of time.
Some possible side effects of prednisone are
- weight gain
- thinning of the bones, a condition called osteoporosis
- thinning of the hair and skin
- diabetes
- cataracts
- glaucoma
Azathioprine can lower white blood cell counts and sometimes causes nausea and poor appetite. Rare side effects are allergic reaction, liver damage, and pancreatitis, which is an inflammation of the pancreas gland with severe stomach pain.
Do Patients Recover From Autoimmune Hepatitis Treatment
Autoimmune hepatitis is a chronic condition, and while it can be managed, it usually cannot be cured. It is possible to achieve remission from autoimmune hepatitis with the use of steroids. However, most individuals will require treatment for the rest of their lives. The 10-year survival rate for people being treated for autoimmune hepatitis is between 83.8%94%. Without treatment, the survival rate falls to 50%60%.
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What Do Researchers Know About What Causes Autoimmune Hepatitis
Autoimmune hepatitis is believed to be caused by a combination of genetic and environmental factors. The condition can be triggered by an environmental factor when you are already genetically predisposed to it. The genes HLA DRB1*03 and HLA DRB1*04 have both been linked to an increased risk of autoimmune hepatitis. Autoimmune hepatitis can also be triggered by certain medications or other diseases.
How To Use Prednisone And Azathioprine
There is no treatment schedule applicable to all AIH patients. The suggested algorithms and treatment schedules must be tailored to the single patient, taking into account the severity of the disease, age and co-morbidities.
The AASLD guidelines published in 2010 recommend two alternative schedules: either prednisone alone at a dose of 60 mg/d or a combination of prednisone 30 mg/d and azathioprine 50 mg/d as initial treatment, favouring the latter because of fewer steroid side-effects. However, as azathioprine can be hepatotoxic, particularly in cirrhotic and jaundiced patients, the more recent guidelines by the European Association for the Study of the Liver recommend that it is added after two weeks of steroid monotherapy , when partial disease control has been achieved. In addition, this approach avoids the problem of distinguishing between azathioprine-induced hepatotoxicity and non-response, this distinction being an important issue in clinical practice. A retrospective series of 133 adult patients reports better results with a combination of steroids and another immunosuppressant from disease presentation compared to steroids alone or steroids followed by the addition of azathioprine/other immunosuppressants. Of note, only 2% of the patients included in this study were jaundiced at presentation, possibly explaining the high remission rate on azathioprine, without hepatotoxicity.
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How Does Hepatitis Affect You
Hepatitis is a condition in which the liver swells and becomes inflamed. Other factors, such as chronic alcoholism and steroids abuse, can cause liver damage, even in the absence of a virus. A variety of factors determines hepatitis incidence. Hepatitis A is the least serious type of hepatitis it is normally short-lived, and patients typically recover without medical intervention.
How Is Autoimmune Hepatitis Treated In A Child
Autoimmune hepatitis is a serious, long-lasting disease. Right now, there is no cure for autoimmune hepatitis. Fortunately, most children with autoimmune hepatitis respond well to treatment.
The goal of autoimmune hepatitis treatment is remission. This means symptoms become less severe and liver damage slows or stops. Some children are able to stop taking medicine after two or three years. These children will still need to be watched for a return of autoimmune hepatitis symptoms and other health issues.
Two main types of medicine are used to help control autoimmune hepatitis in children:
- Corticosteroids . Prednisone helps stop the immune system from attacking the liver. It also reduces liver inflammation. Budesonide is another corticosteroid that is sometimes used it has less side effects, but it is mostly given later on when the disease is under control already.
- Immunosuppressants. Azathioprine or mercaptopurine are often added to the treatment they work together with prednisone to get the immune system under control. There are other medications to suppress the immune system that can be used if the standard treatment is not working well.
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What Is The Outlook
With treatment, most people with autoimmune hepatitis have a normal life expectancy and feel well most of the time. The treatment used for autoimmune hepatitis has improved the outlook tremendously. It is very important that you do not stop your treatment too early without your doctor’s knowledge, as your hepatitis may return. Although the condition usually returns at some point after stopping treatment, it can usually be treated again by quickly going back on medication.
There is a very small increased risk of developing liver cancer, especially if you also have ‘scarring’ of the liver due to your autoimmune hepatitis. Some doctors recommend a blood test and an ultrasound scan of your liver every so often to screen for this.
Abuse With Steroids And How To Get Rid Of It
Steroid use to enhance athletic performance is particularly dangerous users risk having severe health conditions such as chronic hepatitis. Steroid abuse can become addictive. Current views recommend that treatment for steroid use address the underlying causes of steroid abuse.
This Can Include:
- Endocrine therapies restore function in those suffering from hypogonadism and alleviate symptoms of depression.
- Antidepressants for those whose depression does not respond to endocrine therapies.
- Pharmacological and psychosocial treatments for patients who are also dependent on opioids, which appear also to be effective in alleviating signs of anabolic steroid dependence.
Our certified addiction counsellors will answer your questions about steroid addiction. Call our toll-free helpline at if you or anyone you know needs care for steroid abuse.
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Is There A Cure
Not yet. Since we do not know exactly what causes autoimmune hepatitis, we do not yet have a medical cure for the condition. Steroids and other anti-inflammatory drugs can certainly control the inflammation in the majority of cases. However, in certain patients in whom the inflammation continues or who have not been detected and diagnosed until very late in the course, cirrhosis can occur. Cirrhosis is a condition characterized by increased scar tissue that destroys the normal architecture of the liver.
Even if cirrhosis occurs, patients who have a mild disease without active inflammation generally do well and can live many years or decades without problems. If inflammation continues, the cirrhosis usually worsens, eventually reaching a stage called end-stage liver failure. If this stage has been reached, liver transplantation can be used in some patients to successfully treat the condition.
What Causes Autoimmune Hepatitis In Children
It is not known exactly why the immune system begins attacking liver cells in children with autoimmune hepatitis.
Experts are looking at a number of possible causes, including:
- Genetics. Physical traits passed down from parents
- Environment. Causes of disease from outside the body, such as toxic substances, certain medicines, or germs
- Problems with the immune system. For example, in patients with autoimmune hepatitis, it seems that some cells that regulate the immune system are fewer or weaker, while other cells that make the immune system attack are more frequent or more active.
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Dr. Weymann leads a team of highly skilled specialists dedicated to caring for children suffering from a wide range of liver diseases. Named to the Best Doctors in America list, Dr. Weymann understands that liver problems can be life-threatening and life-changing. Quick evaluation, correct diagnosis and early treatment can impact long-term health.
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Why Do We Treat Autoimmune Hepatitis With Steroids And Azathioprine
Despite the limitations of these early trials, prednisone ± azathioprine remains the mainstay of treatment for AIH, several reports showing high remission rates and favourable outcomes in both adult and juvenile AIH.
Of note, azathioprine monotherapy, though unsuccessful in the induction of remission, is effective in adults as maintenance therapy, at a dose of 2 mg/kg per day. A 5-patient report suggests that it may be effective also in children. In a recent retrospective series, 87% of 66 children with AIH were reported to maintain sustained biochemical remission in association with low 6-thioguanine nucleotides levels on an azathioprine dose of 1.2-1.6 mg/kg per day with or without associated steroids.
Living With Autoimmune Hepatitis: What Can Help
Autoimmune hepatitis is a rare disease in which the body’s immune system attacks the cells of the liver. Like other autoimmune diseases, researchers don’t know what causes autoimmune hepatitis for the approximately 100,000-200,000 people living with the condition in the U.S.
AIH symptoms vary, but often include fatigue, itching, aching joints, and abdominal pain. Fatigue and medications with unpleasant side effects can make living with autoimmune hepatitis feel exhausting. These tips, which include learning more about the condition, knowing what to expect, and finding support can help you live better with the condition.
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What Are The Current Treatment Options
Very mild cases or inactive phases of the disease may not require treatment. However, for more serious cases, treatment to fight acute episodes is important.
For many individuals, lifelong medication use may be required to keep the bodys autoimmune response under control and preserve liver health.
The two main medications used to treat autoimmune hepatitis are:
- prednisone: a corticosteroid
- azathioprine: an immunomodulator or steroid-sparing agent
Other medications may be added in severe cases. If medications are no longer effective and liver failure is likely, a liver transplant may be necessary.
If possible, your treatment should be supervised by a hepatologist, which is a physician who specializes in liver health.
Are Other Treatments For Autoimmune Hepatitis Available
People who do not respond to standard immune therapy or who have severe side effects may benefit from other immunosuppressive agents such as mycophenylate mofetil, cyclosporine, or tacrolimus. People who progress to end-stage liver diseasealso called liver failureor cirrhosis may need a liver transplant. Transplantation has a 1-year survival rate of 90 percent and a 5-year survival rate of 70 to 80 percent.
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Autoimmune Liver Diseases Occur When The Bodys Immune System Attacks The Liver Causing Inflammation If Left Untreated The Liver Inflammation May Eventually Cause Cirrhosis Of The Liver Which May Lead To Liver Cancer And Liver Failure
Overview and Symptoms
Although a number of autoimmune conditions may involve the liver, the three most common autoimmune liver diseases are autoimmune hepatitis, primary biliary cholangitis and primary sclerosing cholangitis. These conditions may occur individually or as part of overlap syndromes.
What Are The Symptoms Of Autoimmune Hepatitis In A Child
Both Type I and Type II autoimmune hepatitis have similar symptoms. Autoimmune hepatitis symptoms can come on suddenly or may develop over time. Some children with autoimmune hepatitis do not show any obvious symptoms such children may only be diagnosed because of abnormal blood test results. When symptoms do appear, they may include:
- Fatigue
- Pale or gray stool
- Aches in joints
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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 Is Autoimmune Disease
One job of the immune system is to protect the body from viruses, bacteria, and other living organisms. The immune system usually does not react against the bodys own cells. However, sometimes it attacks the cells it is supposed to protect this response is called autoimmunity. Researchers think certain bacteria, viruses, toxins, and drugs trigger an autoimmune response in people who are genetically susceptible to developing an autoimmune disorder.
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Preparing For An Appointment
If you have any signs or symptoms that worry you, start by making an appointment with your primary care doctor. If your doctor suspects you may have autoimmune hepatitis, you may be referred to a specialist in liver diseases .
Because appointments can be brief and there’s often a lot to discuss, it’s a good idea to be prepared for your appointment. Here’s some information to help you get ready and know what to expect from your doctor.
Is There Anything I Can Do To Help My Liver Heal Itself
No, not directly. However, you can help by giving your liver favourable working conditions, by eating a healthy well-balanced diet, not smoking, and drinking alcohol only in modest amounts or abstaining altogether. Obesity may result in fat deposits in the liver and increases the surgical risk with transplantation. Therefore, if you are overweight, strive for a gradual and sustained weight loss. Introduce exercise into your routine: you can enjoy walking, swimming, gardening, stretching. Please remember that a healthy diet and exercise are important components of any weight-loss regimen.
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How Do Steroid Users Get Hepatitis
Steroids can harm the liver and induce hepatitis. Steroid abuse occurs when athletes use excessive amounts of steroids, increasing the risk of liver damage. The consequences of taking such heavy doses of steroids are unknown. Clinical studies containing exorbitantly large levels of steroids would put the research subjects at risk of severe health issues, so they havent been performed. The majority of evidence for the effects of high doses of steroids comes from studies of individuals who took the medications independently. Although steroids are used for medical purposes, excess doses can also cause liver damage, which means the risk of Steroid Abuse increases with increased doses.
Indirectly, steroid abuse can induce hepatitis if a contaminated needle is used during the intravenous injection. Infection with the virus Steroid Abuse can cause infection with hepatitis if the blood of an infected individual gets into contact with the blood. Hepatitis is a possibility for anyone who injects drugs of any kind, and steroids are no exception.
Symptoms Of Autoimmune Hepatitis
There are two forms of autoimmune hepatitis: type 1 and type 2. The majority of patients have type 1, which typically begins in adolescence or young adulthood. Almost half of individuals with type 1 disease also have other autoimmune disorders, including:
- Type 1 diabetes
- Ulcerative colitis
- Thyroiditis
Autoimmune hepatitis is a chronic disorder with symptoms that can worsen over time if not treated. Symptoms include:
- Fatigue
- Abdominal pain on the right side of the body where the liver is located
- Jaundice
- Dark urine
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What Are The Symptoms Of Autoimmune Hepatitis
Fatigue is probably the most common symptom of autoimmune hepatitis. Other symptoms include:
- an enlarged liver
- dark urine
- pale or gray-colored stool
People in advanced stages of the disease are more likely to have symptoms related to chronic liver disease, such as fluid in the abdomenalso called ascitesand mental confusion. Women may stop having menstrual periods.
Symptoms of autoimmune hepatitis range from mild to severe. Because severe viral hepatitis or hepatitis caused by a drugfor example, certain antibioticshave the same symptoms as autoimmune hepatitis, tests may be needed for an exact diagnosis. Doctors should also review and rule out all medicines a patient is taking before diagnosing autoimmune hepatitis.