Autoimmune hepatitis

Hepatitis these are characterized by the presence of autoantibodies. Without treatment they develop a chronic fashion to cirrhosis and liver failure. They affect more willingly women and young people.

Autoimmune markers are:

- Hypergammaglobulinemia (see IMMUNOGLOBULINS)

- Increasing the SUPPLEMENT,

- The presence of autoantibodies antimuscles smooth autoantibody antimicrosomal liver and kidney (LKM).

Other variables antibodies can be found, such as antinuclear antibodies.

These hepatitis are usually treated with immunosuppressants (cortisone, azathioprine).

Two types of autoimmune hepatitis can be described:

- Autoimmune hepatitis type I that is seen in young women and is also called lupoid hepatitis. The diagnosis is based on the smooth antimuscles antibody presence of antinuclear antibodies in 30-80% of cases.

Two peaks are observed maximum frequency of 10 to 25 years and 45 to 70 years. The onset is usually insidious but sometimes flu-like. In 30% of cases the diagnosis is made at the stage of cirrhosis.

Symptoms: fatigue, loss of appetite, fever, joint pain, cessation of menstruation, diarrhea. A large liver was observed in 70% of cases. Biologically, increased transaminases is clear, 10 to 20 times higher than normal.

- Autoimmune hepatitis type II characterized by the presence of antibodies antimicrosomal liver and kidney (anti LKM1). It affects children and even infants. It may be associated with other autoimmune diseases such as insulin-dependent diabetes and vitiligo.

You should know that hepatitis C may be associated with autoimmune hepatitis type II (LKM +). We find antinuclear antibodies and smooth antimuscles antibodies. It must be very careful in this case not to make misdiagnosis because the treatment is different.

The hepatitis C treated with interferon. The autoimmune hepatitis by immunosuppressants. These immunosuppressants are either cortisone or azathioprine (IMUREL). A British study (Johnson et al) seems to prove the superiority of azathioprine on cortisone to maintain remission. It also seems more effective in the long term.

Combination therapy over azathioprine and azathioprine only by significantly reducing the dose upon discontinuation of cortisone cortisone seems currently the treatment of choice. Of course, the attending medical team determined solely by the protocol to be adopted.

Misdiagnosis, and thus the resulting treatment can worsen the damage in both cases.

The search for viral RNA by PCR (polymerase chain reaction) is then essential in doubt. It can detect the presence of hepatitis C virus.