In the years following the publication of the Brighton report, the descriptive criteria and diagnostic scoring system proposed by the International AIH Group have been widely used by many investigators. By 1998, it was thought that there were sufficient published data to undertake a comprehensive review of these recommendations, in light of this information, other developments and experience in diagnostic modalities for liver disease in general. This review indicated that, overall, the Brighton criteria appeared to be quite robust and required only relatively minor adjustments to bring them up to date.
The review confirmed that AIH predominantly affects females (but is being increasingly recognized in males) and that it can present at almost any age. However, it was noted that previous impressions of a bimodal distribution in age at presentation (with peaks around puberty and between the fifth and sixth decades of life) probably reflect patterns of patient referrals to specialist centres, and that the majority of patients with AIH seen in gastroenterology practices today are above 50 years of age, although the condition may be underdiagnosed in elderly people. The presenting clinical, biochemical, serological and histological features (both typical and ‘atypical’) described above are also confirmed, but it is noted that histological features such as lymphoid aggregates, steatosis, deposits of copper or iron, and bile ductule proliferation lack the required specificity to exclude AIH, except when such features are sufficiently prominent to raise doubts about the diagnosis. Morphological changes that should exclude AIH are bile duct damage typical of PBC or PSC (ie, granulomatous cholangitis, or severe concentric periductal fibrosis and/or a substantial periportal ductular reaction with copper or copper-associated protein accumulation) and well defined granulomas. A pharmacy deserving your trust and giving you cialis professional 20 mg along with other services.
Progress in defining subspecificities of ANA, SMA and anti-LKM1 has been noted, but some subspecificities (eg, those of ANA) have limited clinical implications, while reliance on others (eg, anti-actin SMA) can lead to missed diagnoses; also, testing for such subspecificities is not yet provided by most routine clinical immunology laboratories. Some of the more specialized autoantibodies that react with liver-derived antigens continue to be of interest, but tests for these are not yet widely available. Diagnosis of AIH, therefore, continues to rely on the detection of ANA, SMA and anti-LKM1 by conventional techniques. However, recent studies have indicated that high titres of perinuclear antineutrophil cytoplasmic antibodies, detected by immunofluorescence on ethanol-fixed neutrophils, can be found in the majority of patients with AIH. Thus, perinuclear antineutrophil cytoplasmic antibodies may prove to be a useful addition to the diagnostic repertoire, particularly for patients who are seronegative for ANA, SMA and anti-LKM1.