GASTROENTEROLOGY ARTICLE OF THE WEEK
February 20, 2003
Czaja AJ, Freese D. Diagnosis and treatment of autoimmune hepatitis. Hepatology 2002;36:479-497.
1. Histologic findings in AIH
a. are diagnostic for the disease
b. interface hepatitis is the hallmark finding
c. the absence of plasma cells makes the diagnosis highly unlikely
d. liver biopsy is used to confirm the diagnosis
e. liver biopsy is used to establish severity and prognosis
2. Autoantibodies in AIH
a. high titer suggests aggressive disease
b. may be initially negative and become positive with follow-up
c. titers should be monitored during treatment to see if the patient is responding
d. AIH should not be excluded because the auto antibody titer is low
3. Common medications likely to produce an autoimmune-like hepatitis picture include
a. acetaminophen
b. minocycline
c. nitrofurantoin
d. amiodorone
e. statins
f. alfa-methyldopa
True or False
4. Sustained aminotransferase levels >10 times ULN or >5 times ULN plus gamma globulin levels >2X ULN identify patients with early mortality.
5. To establish the diagnosis, an autoimmune marker should be present, in the absence of ANA and ASMA, the presence of ASGPR, SLA, anti-actin or pANCA may support the diagnosis.
6. Patients with AIH and cirrhosis are less likely to respond to treatment compared to those without cirrhosis.
7. AIH may recur after transplantation despite post-transplant immunosupression; cyclosporine-based regimens have a higher risk of recurrence.
8. Pregnancy is contraindicated in women with AIH.
9. Histologic improvement lags behind biochemical improvement by 3-6 months and therapy should be continued for at least 3 to 6 months after enzymes normalize.
10. Patients with positive SLA are more likely to relapse on treatment withdrawal than other AIH patients.
11. ANA with or without SMA is present in 67% of AIH patients; SMA is present in 87%.
12. Azathioprine alone is not effective in maintaining long-term remission.
13. Anti ASGPR
a. directed against the biliary epithelium
b. the presence of anti ASGPR correlates with histologic activity
c. the titer of anti ASGPR drops as treatment response occurs
d. persistence of anti ASGPR on treatment predicts relapse if treatment stopped
14. Treatment should be considered in which of the following patients with AIH
a. normal liver enzymes and cirrhosis with minimal inflammation on biopsy
b. aminotrasferases > 10X ULN
c. aminotransferases > 5x ULN + gamma globulin level > 2x ULN
d. aminotransferases 3-4x ULN + normal gamma globulin level
e. aminotransferases 3x ULN, gamma globulin 1.3x ULN, biopsy shows
bridging necrosis
15. Single agent treatment using prednisose alone is recommended for:
a. elderly females with early menopause
b. patients contemplating pregnancy
c. short-term trial to assess for response
d. patients with TMPT deficiency or decreased activity