Diagnosis and treatment of autoimmune hepatitis at age 65 and older.
OBJECTIVE
To study features in older patients with autoimmune hepatitis, as this was considered mainly a disease of young females.


METHODS
Analysis of 28 patients diagnosed at age > or =65 years compared with 84 younger patients.


RESULTS
The incidence was similar at all age decades. The ratio M:F was 1:3 (> or =65 years) vs. 1:2 (<65 years). Presenting symptoms were not different when compared with younger patients and consisted of general malaise and fatigue (36%), jaundice +/- other symptoms (50%), or ascites (11%). Antinuclear antibodies (ANA) > or = 1/80 were positive in 93%, smooth muscle antibodies (SMA) > 1/40 in 50%, anti-liver kidney microsomes (anti-LKM) proved always negative. Histology showed acute necrotizing hepatitis in 19%, severe interphase hepatitis in 15%, chronic hepatitis with plasmo-lymphocytic infiltrate in 30%, cirrhosis in 29% (with active inflammation in one-third); biopsy was refused in 11%. The elderly responded very well to low doses of methylprednisolone (< or =8 mg) and azathioprine (1 mg/kg). This schedule obviates side-effects such as infections seen with higher dosages.


CONCLUSIONS
Autoimmune hepatitis has to be also looked for in the elderly with acute and chronic hepatitis. The steroid therapy should be individualized but kept at a low dose.
Verslype
C
C
Department of Medicine, Division of Liver and Pancreas Diseases, University Hospital Gasthuisberg, B 3000 Leuven, Belgium.
George
C
C
Buchel
E
E
Nevens
F
F
van Steenbergen
W
W
Fevery
J
J
D000368:Aged; D000906:Antibodies / Q000097:blood; D000974:Antibodies, Antinuclear / Q000097:blood; D001379:Azathioprine / Q000008:administration & dosage; D002908:Chronic Disease; D004359:Drug Therapy, Combination; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage; D019693:Hepatitis, Autoimmune / Q000175:diagnosis* / Q000188:drug therapy; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage; D009130:Muscle, Smooth / Q000276:immunology
D000906:Antibodies; D000974:Antibodies, Antinuclear; D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D001379:Azathioprine; D008775:Methylprednisolone