Clinical features of type 1 autoimmune hepatitis in elderly Italian patients.
BACKGROUND
The usual onset of type 1 autoimmune hepatitis occurs at puberty or around menopause, whereas disease presentation in the advanced age is less often reported.


OBJECTIVE
To assess the clinical, immunological and histological features of Type 1 autoimmune hepatitis in elderly Italian patients.


METHODS
We assessed, at diagnosis, the clinical and immunological features of 76 consecutive Italian patients with type 1 autoimmune hepatitis, focusing particularly on a subgroup of 20 patients presenting at > or = 65 years (females 95%, median age 72 years, range 65-82).


RESULTS
In comparison with the younger group, at the time of autoimmune hepatitis diagnosis, elderly Italian patients are more often asymptomatic (25% vs. 7%; P = 0.04), are more frequently positive for antinuclear autoantibodies (95% vs. 52%; P = 0.0004) and HLA-DR4 (45% vs. 18%; P = 0.03); among the extra-hepatic manifestations, autoimmune thyroid disorders are prevalent in the elderly group (25% vs. 5%; P = 0.02). However, no difference was observed in the histological/biochemical expression of the liver disease and response to immunosuppression.


CONCLUSIONS
In elderly Italian patients, autoimmune hepatitis has typical serological and genetic characteristics, is more frequently asymptomatic, although prognosis and response to therapy is similar to that of younger patients. As a concomitant autoimmune thyroid disorder is common, autoimmune hepatitis should be suspected and investigated in elderly patients with autoimmune thyroid disorder and abnormal liver function tests.
Granito
A
A
Department of Internal Medicine, Cardioangiology, Hepatology, Alma Mater Studiorum, University of Bologna, Policlinico Sant' Orsola-Malpighi, Bologna, Italy. gralex@libero.it
Muratori
L
L
Pappas
G
G
Muratori
P
P
Ferri
S
S
Cassani
F
F
Lenzi
M
M
Bianchi
F B
FB
D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000974:Antibodies, Antinuclear / Q000097:blood; D001327:Autoimmune Diseases / Q000150:complications; D001379:Azathioprine / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D015804:HLA-DR4 Antigen / Q000097:blood; D019693:Hepatitis, Autoimmune / Q000175:diagnosis* / Q000188:drug therapy / Q000276:immunology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D008875:Middle Aged; D011379:Prognosis; D013959:Thyroid Diseases / Q000150:complications
D000974:Antibodies, Antinuclear; D015804:HLA-DR4 Antigen; D007166:Immunosuppressive Agents; D001379:Azathioprine; D008775:Methylprednisolone