Autoimmune hepatitis is a progressive, chronic hepatitis of unknown cause that occurs in people of both sexes and all ages.The disease is relatively rare. It is an auto-immune disease, which means the patient’s own immune cell target the liver and thereby causing local inflammation. Why this happens is unfortunately unknown.
Autoimmune hepatitis has been considered a disease occurring predominantly in young women, but up to one third of the patients are men, and the disease can develop in all age groups. Patients can present within the broad spectrum of generally a-specific symptoms, ranging from no or mild symptoms to fulminant hepatic failure. Although the clinical findings can vary substantially, a chronic fluctuating course is most common. Up to 40 percent of patients present with acute hepatitis, but either a fulminant presentation or a long subclinical course with only minimal elevations of liver enzymes may be seen. .
The diagnosis is based on the exclusion of other genetic or infectious liver diseases, exclusion of toxic (medicinal or alcoholic) agents, biochemical abnormalities, serologic markers and histological characteristics in liver biopsy.
The short- and long-term efficacy of immune suppression in patients with autoimmune hepatitis has been demonstrated unequivocally. Without treatment AIH will cause liver cirrosis (scar tissue) and in the end liver faillure. In untreated AIH, 5-year survival is only 20%. Fortunately, in 90 percent of all patients, treatment with immuno suppresive drugs is succesfull.
Altough treatment is succesfull in most cases, the use of immunosuppresice drug has some important side effects. Commonly used prednison can cause bone demineralisation and diabetes. Progress toward a more rational therapy for AIH is being made because an improved understanding of its underlying pathogenic mechanisms and the emergence of powerful site specific immunosuppressive agents. With the filling of the gaps in our knowledge of pathofysiological mechanisms and genetical backgrounds, it is likely that the development of new and improved agents continues, with an effective therapy, suited to the personal clinical situation of the patient as an ultimate goal.