Auto-immune Hepatitis

  I was diagnosed  (age 40) with auto-immune hepatitis at the Cleveland Clinic about 11 years ago and have been taking prednisone  (8 mg)and imuran  (50 mg ) ever since. My liver function tests have both been in the 70's / 80's for several years. Other than the obvious side effects of the steriods, I feel great. My questions are (1) I'm very concerned about the long term side effects of prednisone, especially bone loss, and (2) is there any possibility that the prednisone itself could be causing my liver enzymes to be elevated?  What long term problems could I be facing with the long term steriod use? Are there any new treatments on the horizon?

[HFHSM.D.-D.M.]

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Dear Becky:
I appreciated your questions and I certainly appreciate your concerns about the long term use of steroids.  Let me make a couple of comments that hopefully will be helpful to you.
Long term use of prednisone can result in side effects and that is one of the reasons we try to use as little as possible.  Your dose of 8 mg is reasonable.  Prednisone use can result in bone loss, however, there are now effective methods and medications to try to limit this bone loss.  We like to periodically obtain bone densitometry on some of our patients on prednisone to make sure that bone loss is not becoming a problem.  In addition, prednisone can also cause diabetes, hypertension and cataracts (in the eyes) though again we like to keep an eye out for these things and control them.  Certainly it is important to balance these side effects against the dangers of uncontrolled liver disease.
You ask whether prednisone could be causing your elevated liver enzymes.  While I cannot completely rule out this possibility, I would consider it very unlikely.  If anything, of your two drugs, imuran is more frequently known to cause elevated liver enzymes though this too is somewhat unusual.  
There are many drugs that doctors are looking at for autoimmune hepatitis and I am hopeful that some will be effective.  At this time, there is nothing that is so dramatically effective that I feel you should consider it immediately.  For the time being corticosteroids (prednisone) in conjunction with imuran remain the mainstay of treatment.  
Good luck with your condition.  I hope the information is helpful to you. As always, if you have additional questions or more information, feel free to post the material back to MEDHELP or you are always welcome to contact us directly at Henry Ford at [phone].  If you are in the Michigan area, we would always invite you to visit us.  
This response is being provided for general informational purposes only and should not be considered medical advice or consultation.  Always check with your personal physician when you have a question pertaining to your health.