Hepatitis - Autoimmune Hepatitis

Highlights	Hepatitis B and D	Outlook
Introduction	Hepatitis C	Resources
Diagnosis	Autoimmune Hepatitis	References
Hepatitis A	Symptom Management

Autoimmune Hepatitis

Autoimmune chronic hepatitis typically occurs in women between the ages of 20 and 40 who have other autoimmune diseases, including systemic lupus erythematosus, rheumatoid arthritis, Sjgren's syndrome, inflammatory bowel disease, glomerulonephritis, and hemolytic anemia. Some research indicates that the postmenopausal period may be another peak in incidence of AIH among women. About 30% of patients are men, however, and in both genders there is often no relationship to another autoimmune disease. In general, no major risk factors have been discovered for this condition.

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Symptoms of Autoimmune Hepatitis

About 85% of people with chronic active autoimmune hepatitis do not have severe symptoms at all. When symptoms occur, they range from minimal to severe, and include fatigue, jaundice, fever, and weight loss. The liver and spleen are often enlarged. In addition, patients with this condition may experience skin disorders, including palmar erythema (red palms) and spider angioma (a blood-red spot, the size of a pinhead, from which tiny blood vessels radiate like spider legs). Itching is not common, however. The abdomen or legs may be swollen due to the accumulation of fluid.

Tests for Autoimmune Chronic Hepatitis

If a patient experiences symptoms of chronic active hepatitis for six months or more and a virus cannot be identified, then autoimmune hepatitis is usually suspected. There are other autoimmune liver diseases, however, that can confuse a diagnosis. To help confirm this condition, test results may show high levels of immune factors called serum globulins or certain antibodies to liver proteins. In some cases, a successful trial of steroid drugs may be the only way to diagnose autoimmune hepatitis.

Outlook for Autoimmune Hepatitis

Autoimmune hepatitis is usually benign and causes little trouble, although there is a very small risk that it can evolve into the active form. One study reported a 10-year survival rate of 95%, which was similar to the same age group in the general population. However, it the condition evolves into the chronic active form, five-year survival rate may be only 50% if the disease is not treated. (The survival rate can be higher in people with milder symptoms and less liver damage.)

Although very uncommon, severe autoimmune hepatitis can be life-threatening and require intensive therapy, including possibly liver transplantation. The risk for liver failure and bleeding in the stomach and esophagus is highest in the early years after disease onset. This risk diminishes over time but is replaced by an increase in liver cancer rates and bleeding in the stomach and intestines. The risk for liver cancer is not as high, however, as with chronic viral hepatitis.