In order to reduce the dose of prednisolone needed the
doctor looking after you will often choose to start you, at
some point, on an additional drug treatment. In most
people the drug used is azathioprine (in some individuals
other agents will be chosen). Azathioprine and related drugs are very effective at reducing the doses of
prednisolone required to keep autoimmune hepatitis under control (sometimes to the point where no prednisolone is eventually needed). They are not, however, effective at bringing the disease under control in then first place.
The treatment of autoimmune hepatitis is extremely effective at both controlling the symptoms of the disease and reducing the risk of chronic liver disease and cirrhosis developing in the future.
The mainstay of treatment for autoimmune hepatitis is
drug therapy. You can help yourself, however, by keeping,
in general terms, healthy and in particular, avoiding excess
alcohol consumption. As a number of drugs and
medications are normally cleared by the liver, and can
cause liver damage in their own right, you should discuss
any medication you intend to take with your doctor.
LIVERNORTH is the regional liver patient support
charity and has provided this leaflet free of charge.
Can I pass it on to anyone else?No. This condition is not related in any way to Hepatitis B
President: Professor OFW James MA BM BCh FRCP FAMSci
Professor David Jones BM BCh MA PhD FRCP of the
University of Newcastle upon Tyne Medical School for his
professional contribution to this information leaflet.
As well as having many of the Freeman’s health professionals as
Dr PT Donaldson BSc PhDDr H Mitchison MD FRCP
members, we have access to extensive information on all liver diseases and treatments.
Information leaflets are available explaining each specific liver disease; some of these are available for free download from our
This leaflet is for information only. Professional, medical or
website (details below), others can be supplied free of charge on
other advice should be obtained before acting on anything
request (telephone, mail or email us). contained in this leaflet. LIVERNORTH can accept no responsibility as a result of action taken or not taken because
The reasons why the immune system should lose the
Autoimmune hepatitis is a condition in which the liver is
ability to discriminate between "self" and "foreign" and
Where the condition is suspected (because of the
progressively damaged by the bodies own defence system
cause autoimmune disease of the liver (and indeed any
presence of suggestive symptoms) the first test to be
(the immune system). Over time, what starts as mild
tissue) remain unclear. Current thinking is that two
carried will be the liver function tests (LFTs). This is a
damage can become more extensive and result in
factors probably play a role. These factors are an
blood test which assesses for the presence of damage to
permanent damage to the liver. Because this damage takes
individuals genetic make-up (the characteristics of each of
the cells of the liver. If abnormal it suggests that damage is
place over a long period of time the body tries to repair it
our immune systems are determined by our genes) and
occurring, but does not identify what is causing the
(the liver actually as an impressive capacity to repair and
some form of trigger (probably an otherwise harmless
damage. The next test to be carried out will be a blood
heal itself). The presence, at the same time, of damage
virus which manages to "irritate" the immune system.
test looking for the presence of specific antibodies in the
and repair can result in the development of cirrhosis.
blood which are suggestive of the presence of
What problems does autoimmune hepatitis cause?
autoimmune hepatitis. If these blood tests suggest that
Cirrhosis. Does that mean it is caused by drinking
Patients with autoimmune hepatitis develop two types of
autoimmune hepatitis is present it is extremely important
to confirm the diagnosis (to allow effective treatment and
NO! It is a popular misconception that the term cirrhosis
to assess how severe the existing liver damage is). One
refers to liver damage caused by drinking too much
The first type of problem results from chronic damage to
way of confirming the diagnosis is with a liver biopsy (a
alcohol. This is not the case. The term cirrhosis refers to
the liver resulting, eventually, in the development of
procedure where, under local anaesthetic, a needle is
the combination of liver scarring caused by chronic liver
cirrhosis. Whilst loss of hepatocytes initially causes little
used to remove a tiny piece of liver tissue which is then
damage and the attempts made by the liver to regenerate
problem (the liver normally has a huge amount of spare
itself. Any cause of chronic liver damage (and there are
capacity) eventually in-sufficient hepatocytes may remain
probably well over 100) can result in cirrhosis.
to perform the normal functions of the liver. This can
Once the disease has been diagnosed and, where
result in, amongst other things, the development of
appropriate, treatment started, the response to
What does cause autoimmune hepatitis then?
jaundice and problems with blood clotting (the clotting
treatment will be monitored primarily through the use of
The short answer is that we do not know. We have, over
factors which are needed to make the blood clot are
further blood tests. Occasionally it will be necessary to
millions of years, evolved an immune system that is
mostly made by the liver). Where cirrhosis develops as a
repeat the liver biopsy to monitor response to treatment.
extremely effective at protecting us against infection (we
result of chronic liver damage additional problems caused
all encounter thousands of potentially harmful bugs each
by an increase in the pressure of blood within the blood
year and yet most us, for most of the time, suffer no ill
vessel connecting the bowel and the liver (the portal vein)
Because the principal problem in AIH is an over-activity
effects at all). The immune system, which works to protect
can develop (portal hypertension). Problems caused by
and incorrect targeting of the immune response the main
us day in day out without us even being aware of it, is so
portal hypertension include development of blood
approach to treatment is to reduce the immune response.
effective because it is able to identify bacteria and viruses
vessels in the gullet with increased risk of bleeding
In the first instance the drug prednisolone will be used.
as being "foreign" and to eliminate them, whilst not
(oesophageal varices) and accumulation of fluid in the
Initially the doses used will be relatively high. They will,
causing damage to the bodies own tissues ("self"). In a
however, be reduced quite quickly (the rate of reduction
number of situations this ability to discriminate between
depending on how well you respond). Patients are often
"self" and "foreign" fails, however, and the immune system
The second type of problem encountered by patients with
concerned at having to take prednisolone because of the
starts to attack the bodies own tissues ("self"). These
autoimmune hepatitis is the symptom set associated with
risk if side effects. The doctors treating you are very
conditions where the immune system turns in on itself are
the inflammatory process going on within the liver. These
aware of the concerns that you are likely to have and will
known collectively as the autoimmune diseases.
symptoms include fatigue and lethargy, and muscle and
do their utmost to keep the doses as low as possible, and
Autoimmune disease can potentially occur in any tissue in
joint pains. These symptoms are important both because
to leave you on the drug for as short a period of time as
the body. Some tissues are more frequently involved than
they can impair quality of life (and respond well to
possible. You do need to be aware, however, that if not
others. These include the thyroid (hypothyroidism) and
treatment) and because they can alert doctors to the
treated properly autoimmune hepatitis can damage the
the joints (rheumatoid arthritis). Where the immune
presence of autoimmune hepatitis at a time when liver
liver very quickly and, at present, prednisolone is the only
system attacks the cells of the liver (the hepatocytes) the
damage can be prevented or reversed by treatment.
drug able to bring that damage under control quickly.
condition is called autoimmune hepatitis.
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