Special ArticleInternational Autoimmune Hepatitis Group Report: review of criteria for diagnosis of autoimmune hepatitis
Section snippets
Review of Diagnostic Criteria
The descriptive criteria appear to have stood the test of time and require at most only minor modifications (see below) to bring them into line with recent developments in diagnostic modalities for liver disease generally. The review has, however, revealed that the scoring system requires some adjustments to improve specificity and simplify its use.
There are six published studies in which the scoring system has been applied to sufficient numbers of patients to allow for meaningful evaluation 5.
Presenting clinical and serum biochemical features
The present review has reaffirmed that there are no particular signs, symptoms or liver test abnormalities that are of sufficient specificity to be considered part of the diagnostic criteria (4). Onset is usually insidious, with fatigue, fluctuating jaundice and arthralgia as typical features, but a substantial proportion of patients either have no obvious signs or symptoms of liver disease or have an (occasionally severe) acute presentation 13., 14., 15.. There is often a history of other
Descriptive criteria
The suggested minor modifications to the descriptive criteria are incorporated in Table 4. Histological features that are considered to lack sufficient specificity individually to exclude AIH have been omitted. The previous (4) separate specification for titres of autoantibodies in children is no longer considered necessary but it is noted that lower titres may be significant. Obligatory exclusion of markers of infection with hepatotropic viruses other than hepatitis A, B and C, and a history
Acknowledgements
We gratefully acknowledge the contribution of Dr. Kirsten Boberg in re-analysing her data on primary sclerosing cholangitis patients using the revised scoring system.
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