Once the diagnosis has been made, treatment is almost always required.
The treatment used is called immunosuppression. This therapy uses a type of steroids, known as corticosteroids, to reduce (suppress) the ability of your immune system to fight infection.
It is usual to start treatment with a relatively high dose of steroids, usually prednisone or prednislone. When the inflammation is brought under control, the dose can be reduced.
Usually other drugs are added to allow for a lower dose of steroids.
Another immunosuppressant, azathioprine, is most commonly used in combination with steroids. This drug is slower acting and has fewer side effects than steroids.
If AIH is well controlled, steroids may be withdrawn completely so that you are maintained on azathiopine only, although this is not always possible.
Autoimmune hepatitis appears more often to be a controllable rather then a curable disease, therefore most patients need long-term maintenance therapy. It may be possible to completely withdraw the immunosuppression but this is not without risk as relapse can occur months, or even years after withdrawal.
Other drugs such as cyclosporin, tacrolimus, mycophenolate and D-penicillamine may also be
considered.
You should not stop taking any of these drugs without first consulting your doctor or specialist.
Liver transplantation
For a few people who eventually develop advanced cirrhosis, a liver transplant may be necessary.
This is a major operation and you will need to plan it carefully with your medical team, family and friends.
Side effects of treatment
Unfortunately, corticosteroids have a number of side effects which your doctor should discuss with you. These are often seen when a high dose is given for a long time.
They can:
• increase appetite
• cause weight gain
• induce diabetes or make diabetes worse
• cause fluid retention (which can lead to puffiness of the face and legs)
• cause indigestion.
They may also cause:
• thinning of the skin and bones. For most people who take steroids, additional treatment may be required to reduce the risk of bone loss
• a tendency to bruise more easily.
If someone has diabetes or hypertension (high blood pressure) these problems may become worse. Corticosteroids may also increase the severity of glaucoma (increased pressure in the eye) or cataracts.