First Nations, Métis and Inuit people with primary biliary cholangitis — a debilitating autoimmune liver disease — have more advanced symptoms at diagnosis and worse long-term outcomes than others in Canada, according to research from a nationwide monitoring project.
“This autoimmune liver disease joins the collection of other autoimmune diseases with increased frequency and severity in Indigenous peoples, including multiple sclerosis, rheumatoid arthritis and systemic lupus erythematosus,” says co-lead author Andrew Mason, hepatologist and professor in the Faculty of Medicine & Dentistry.
“The cause for the increased severity of disease is not clear,” says Mason, who is the Western Canada project lead for the Canadian Network for Autoimmune Liver Disease, which pools data about patients with the relatively rare diseases of primary biliary cholangitis, autoimmune hepatitis and overlap syndrome.
Primary biliary cholangitis is a chronic illness in which the immune system misfires and attacks the bile ducts in the liver, slowly destroying them. It affects an estimated 318 people per million in Canada. Nine out of 10 patients are female, according to the Canadian Liver Foundation. Early symptoms include fatigue and itchiness, with abdominal pain, swelling, jaundice and other symptoms developing later. There is no cure for the disease, although treatments can slow its progression. Some patients eventually experience liver failure and require a transplant.
The researchers examined medical records for 1,538 patients from six cities across the country.
They found that Indigenous patients were more likely to have developed complications such as deteriorated liver function or liver cancer before diagnosis than new patients from other population groups, even though they were diagnosed at about the same age. Indigenous patients also had persistently poorer results on blood tests even after treatment.