Autoimmune hepatitis is considered mainly a disease of young females. Thus a study investigated its features in older patients by analyzing 28 patients diagnosed at age > or =65 years and comparing them with 84 younger patients.

The observations of the study were as follows-

• The incidence was found to be similar at all age decades. 
• M: F ratio was 1:3 in age > or =65 years 
• M: F ratio was 1:2 in age <65 years. 
• Presenting symptoms were similar between elderly and younger patients.
• Common presenting symptoms in both groups were general malaise and fatigue (36%), jaundice +/- other symptoms (50%), or ascites (11%). 
• Antinuclear antibodies (ANA) > or = 1/80 were positive in 93%, smooth muscle antibodies (SMA) > 1/40 were present in 50%, 
• Anti-liver kidney microsomes (anti-LKM) were negative in all.
• Histology revealed- 
• acute necrotizing hepatitis in 19% 
• severe interphase hepatitis in 15%, 
• chronic hepatitis with plasmo-lymphocytic infiltrate in 30%, 
• cirrhosis in 29% (with active inflammation in one-third) 
• 11% refused biopsy. 
• Very well responses to low doses of methylprednisolone (< or =8 mg) and azathioprine (1 mg/kg) were seen in the elderly. 
• It further prevents side effects like infections associated with higher dosages.

Thus it was concluded that autoimmune hepatitis should be considered and investigated in the elderly with acute and chronic hepatitis and the steroid therapy should be individualized and kept at a lower dose.

Source: Aliment Pharmacol Ther. 2005;21(6):695-9. doi: 10.1111/j.1365-2036.2005.02403.x. PMID: 15771755.