Decreased health-related quality of life in children and adolescents with autoimmune hepatitis

Bozzini, Ana Beatriz; Neder, Luciana; Silva, Clóvis A.; Porta, Gilda

doi:10.1016/j.jped.2017.10.013

Cited by 14 publications

(19 citation statements)

References 27 publications

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“…(312,314) Low scores on health-related quality of life assessments have been strongly associated with glucocorticoid use. (319)(320)(321)(322) Pretreatment psychological disturbances, especially depression, may be intensified during glucocorticoid treatment. (321) The combined effects of depression, anxiety, and glucocorticoidrelated emotional lability may impact on treatment outcome.…”

Section: Pretreatment Counselingmentioning

confidence: 99%

“…(321) The combined effects of depression, anxiety, and glucocorticoidrelated emotional lability may impact on treatment outcome. (322,323) Manifestations of depression and changes in the quality of life should be monitored throughout management of AIH as they may justify targeted counseling, individualized adjustments in the doses of glucocorticoids, or adjunctive antidepressive or antianxiety interventions. (317) These manifestations can be assessed by structured, validated questionnaires such as the 12-Item Short Form Survey, the depression module of the Patient Health Questionnaire, and the Generalized Anxiety Disorders Screener.…”

Section: Pretreatment Counselingmentioning

confidence: 99%

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Diagnosis and Management of Autoimmune Hepatitis in Adults and Children: 2019 Practice Guidance and Guidelines From the American Association for the Study of Liver Diseases

et al. 2020

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US children, 9%-12% (14-16) UK children, 38% (13) Age at presentation Peripubertal and adults Usually under 14 years (153) Mode of presentation Chronic symptoms common Acute onset (~40%) Ascites or GI bleeding rare Acute liver failure possible (555,556) Asymptomatic in 25%-34% Relapse frequent (108) Acute in 25%-75% Acute severe in 2%-6% Laboratory features Hypergammaglobulinemia IgA levels may be reduced (153) Autoantibodies ANA Anti-LKM1 SMA, anti-actin [Anti-LC1, Anti-LKM3] SLA Concurrent immune diseases Autoimmune thyroiditis Autoimmune thyroiditis Rheumatic diseases Diabetes mellitus IBD Vitiligo Autoimmune overlap with PSC (ASC in children) Common in children Rare Atypical pANCA-positive Atypical pANCA-negative Overlap with PBC Seen in adults (not children) Not reported Cirrhosis at presentation Adults, 28%-33% (especially elderly) Rare Children, ≤33% Remission after drug withdrawal Possible Rare, usually need long-term immunosuppression Abbreviations: GI, gastrointestinal; IgA, serum immunoglobulin A. *Removed from marketplace. Abbreviation: anti-PD-L1, antibody to programmed death protein ligand 1. taBle 6. Features of Drug-Induced aIH-like Injury and aIH Clinical Features Drug Induced AIH-Like Injury AIH Gender Mainly women (187) Female predominance, but men also affected (2,384,467) Acute onset Majority (>60%) (231) <20% (2,136) Hypersensitivity (fever, rash, eosinophilia) Up to 30% (231,232,613) Unusual (2,384,467) Temporal relationship with drug Positive (231-234) Negative (2,56,188) HLA DRB1*03:01 or DRB1*04:01 association None (236) Common (29) Concurrent autoimmune diseases Unusual (187) Present in 14%-44% (129,149-152) Cirrhosis at presentation Rare (187) 28%-33% (9,104-107) Management Stop offending drug ± glucocorticoids (187,231,232) Glucocorticoids with AZA (2,384,467) Relapse after drug withdrawal Rare (187) 60%-87% (243,244) Progression to cirrhosis Rare (187) 7%-40% (105) Survival without transplantation 90%-100% (187,232) 10-year survival, 89%-91% (105,451

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Section: Pretreatment Counselingmentioning

confidence: 99%

Section: Pretreatment Counselingmentioning

confidence: 99%

Diagnosis and Management of Autoimmune Hepatitis in Adults and Children: 2019 Practice Guidance and Guidelines From the American Association for the Study of Liver Diseases

et al. 2020

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“…The patient population consisted of patients with autoimmune or cholestatic liver disease (19 studies), [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] chronic hepatitis B or C (35 studies), NAFLD or NASH (15 studies), [62][63][64][65][66][67][68][69][70][71][72][73][74][75][76] cirrhosis of different aetiologies (but mainly alcohol and hepatitis) (17 studies), [77][78][79][80][81][82][83][84][85][86][87][88][89][90][91]...…”

Section: Description Of Included Patientsmentioning

confidence: 99%

Quality of life and unmet needs in patients with chronic liver disease: A mixed-method systematic review

Grønkjær¹,

Lauridsen²

2021

JHEP Reports

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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“…Fatigue is a significant component of the clinical presentation of patients with autoimmune hepatitis, often paralleling hepatic inflammation and responding usually quite rapidly to the initiation of immunosuppressive therapy. 8,29,30 However, the overall prevalence of fatigue in patients with viral hepatitis is less clear. Acute presentations of viral hepatitis are often associated with feelings of fatigue and malaise, which gradually subside as the patient recovers clinically.…”

Section: Incidence and Prevalencementioning

confidence: 99%

“…Although the issue of fatigue has been extensively studied in the context of cholestatic liver diseases, including PBC and PSC, the prevalence of fatigue in hepatitic liver diseases is less clearly defined. Fatigue is a significant component of the clinical presentation of patients with autoimmune hepatitis, often paralleling hepatic inflammation and responding usually quite rapidly to the initiation of immunosuppressive therapy . However, the overall prevalence of fatigue in patients with viral hepatitis is less clear.…”

Section: Fatigue In Liver Diseasementioning

confidence: 99%

Fatigue in chronic liver disease: New insights and therapeutic approaches

Swain

Jones

2018

Liver International

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The management of fatigue associated with chronic liver disease is a complex and major clinical challenge. Although fatigue can complicate many chronic diseases, it is particularly common in diseases with an inflammatory component. Fatigue can have both peripheral (i.e., neuromuscular) and central (i.e., resulting from changes in neurotransmission within the brain) causes. However, fatigue in chronic liver disease has strong social/contextual components and is often associated with behavioural alterations including depression and anxiety. Given the increasing awareness of patient-reported outcomes as important components of treatment outcomes and clinical research, there is a growing need to better understand and manage this poorly understood yet debilitating symptom. Although several pathophysiological mechanisms for explaining the development of fatigue have been generated, our understanding of fatigue in patients with chronic liver disease remains incomplete. A better understanding of the pathways and neurotransmitter systems involved may provide specific directed therapies. Currently, the management of fatigue in chronic liver disease can involve a combined use of methods to beneficially alter behavioural components and pharmacological interventions, of which several treatments have potential for the improved management of fatigue in chronic liver disease. However, evidence and consensus are lacking on the best approach and the most appropriate biochemical target(s) whilst clinical trials to address this issue have been few and limited by small sample size. In this review, we outline current understanding of the impact of fatigue and related symptoms in chronic liver disease, discuss theories of pathogenesis, and examine current and emerging approaches to its treatment.

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Decreased health-related quality of life in children and adolescents with autoimmune hepatitis

Cited by 14 publications

References 27 publications

Diagnosis and Management of Autoimmune Hepatitis in Adults and Children: 2019 Practice Guidance and Guidelines From the American Association for the Study of Liver Diseases

Diagnosis and Management of Autoimmune Hepatitis in Adults and Children: 2019 Practice Guidance and Guidelines From the American Association for the Study of Liver Diseases

Quality of life and unmet needs in patients with chronic liver disease: A mixed-method systematic review

Fatigue in chronic liver disease: New insights and therapeutic approaches

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