Immunology

The immune system protects the body against external pathogens while recognising and tolerating its own cells and tissues. In autoimmune diseases, this balance is disrupted, and the immune system may also initiate an immune response against the body’s own structures.

At the SanBer Medical immunology clinic, we assess and provide specialist evaluation for autoimmune diseases—including certain autoimmune and immune-mediated diseases of the liver and bile ducts—and offer follow-up care and long-term management for previously diagnosed conditions.

The findings of an immunological assessment may also be relevant to hepatological and gastroenterological care. The required tests may also be available through SanBer Medical’s blood sampling and laboratory services.

Autoimmune diseases often cause complex symptoms affecting several organ systems. Establishing a diagnosis therefore usually requires more than a single laboratory result. At our clinic, we assess the patient’s symptoms, medical history, previous reports and test results as part of a complete clinical picture and use these findings to prepare a personalised plan for further investigation and follow-up.

What is an autoimmune disease?

Under normal circumstances, the immune system can distinguish the body’s own cells from foreign structures. In autoimmune disease, regulation of the immune system becomes disrupted, and an immune reaction may develop against the body’s own cells, tissues or organs.

Autoimmune diseases can present in many different ways. Some primarily affect a particular organ, while systemic autoimmune diseases may influence several organ systems simultaneously.

Diagnosis is therefore generally based on the combined assessment of symptoms, a detailed medical history, physical examination and the results of laboratory, immunological, imaging and, where necessary, other diagnostic tests.

When should you consult an immunologist?

Autoimmune diseases can be associated with various symptoms that are not specific when considered individually. An immunology consultation may be recommended for:

• persistent or recurring joint pain or swelling,
• prolonged fatigue that cannot be explained by another cause,
• recurring or persistent low-grade fever or fever,
• inflammatory laboratory abnormalities of unknown origin,
• recurring skin rashes or other skin symptoms,
• skin changes associated with increased sensitivity to sunlight,
• dry eyes and dry mouth,
• discolouration of the fingers triggered by cold, known as Raynaud’s phenomenon,
• recurring mucosal ulcers,
• muscle pain or muscle weakness,
• unexplained symptoms affecting several organ systems,
• previous laboratory results suggestive of autoimmune disease,
• persistently or repeatedly elevated liver enzyme levels,
• liver or biliary laboratory abnormalities of unknown origin.

These symptoms do not in themselves confirm the presence of an autoimmune disease. However, specialist assessment may be appropriate if the symptoms are persistent, recurring or occur in combination.

Which conditions are treated in immunology?

Clinical immunology includes the assessment and management of systemic autoimmune diseases and certain autoimmune and immune-mediated diseases of the liver and bile ducts.

These may include:

• systemic lupus erythematosus (SLE),
• Sjögren’s syndrome,
• antiphospholipid syndrome,
• systemic sclerosis,
• inflammatory muscle diseases,
• vasculitis,
• other systemic autoimmune conditions,
• autoimmune hepatitis (AIH),
• primary biliary cholangitis (PBC),
• primary sclerosing cholangitis (PSC),
• certain overlapping autoimmune liver and biliary conditions.

The symptoms and laboratory abnormalities associated with these diseases may overlap considerably. An accurate diagnosis therefore requires a detailed specialist assessment in every case.

Autoimmune liver and biliary diseases

Some diseases affecting the liver and bile ducts may be caused by an autoimmune or immune-mediated process. These conditions may produce few or non-specific symptoms for a long time. In some cases, the first indication is an abnormal liver enzyme level or cholestatic laboratory result detected during a routine blood test.

An immunological and hepatological assessment may be appropriate in cases of:

• persistently elevated liver enzyme levels,
• abnormal liver function of unknown origin,
• laboratory results suggestive of cholestasis,
• autoantibodies suggestive of autoimmune liver disease,
• persistent fatigue,
• itching,
• a previously diagnosed autoimmune liver or biliary disease,
• follow-up of a known condition.

Autoimmune hepatitis

Autoimmune hepatitis (AIH) is a chronic, immune-mediated inflammatory disease of the liver.

Its symptoms can vary. Some patients experience fatigue, a general feeling of being unwell or abdominal symptoms, while in other cases the condition is discovered through elevated liver enzyme levels detected during laboratory testing.

Diagnosis is not based on a single laboratory result. The clinical picture, liver enzyme levels, immunoglobulin levels, autoantibody tests and, where necessary, additional diagnostic examinations must be assessed together.

Primary biliary cholangitis

Primary biliary cholangitis (PBC) is a chronic autoimmune liver disease that primarily affects the small bile ducts within the liver.

The condition may initially be asymptomatic and is frequently suspected because of abnormalities detected during routine laboratory testing. In other cases, fatigue, itching or other symptoms may lead to further investigation.

The clinical picture, liver and biliary laboratory abnormalities and autoantibody test results may all play an important role in establishing the diagnosis.

Primary sclerosing cholangitis

Primary sclerosing cholangitis (PSC) is a chronic, immune-mediated inflammatory disease affecting the bile ducts. It may lead to structural changes and narrowing of the bile ducts.

In addition to laboratory results, imaging of the bile ducts and assessment of the complete clinical picture are particularly important during the diagnostic process.

What does an immunological assessment involve?

The basis of an immunological assessment is a detailed specialist consultation.

During the consultation, the immunologist reviews:

• the patient’s current symptoms and the circumstances in which they developed,
• previous medical conditions,
• regularly taken medications,
• available laboratory and immunological results,
• previous imaging examinations,
• specialist medical documentation,
• any previously diagnosed autoimmune diseases.

Based on the medical history, symptoms and available test results, the specialist determines whether additional targeted laboratory tests, imaging examinations or consultations with other specialists are required.

It is particularly important to understand that a positive autoantibody result or abnormal immunological laboratory finding does not necessarily indicate an autoimmune disease on its own. Results must always be evaluated together with the patient’s symptoms and other test findings.

What does a positive autoantibody result mean?

Autoantibodies detected during immunological laboratory testing—such as certain ANA or other autoantibody abnormalities—do not always mean that the patient has an autoimmune disease.

When assessing the significance of a result, the specialist considers:

• the patient’s symptoms,
• the type and level of the autoantibody,
• other laboratory abnormalities,
• previous medical conditions,
• the results of other examinations.

Following an abnormal immunological laboratory result, a specialist consultation can help determine whether the finding has clinical significance and whether further assessment is required.

Follow-up and management of autoimmune diseases

Many autoimmune diseases require long-term, regular specialist follow-up.

Follow-up examinations provide an opportunity to:

• assess disease activity,
• review new or changing symptoms,
• monitor laboratory results,
• evaluate the effectiveness and tolerability of treatment,
• identify possible organ involvement,
• prepare a personalised plan for further examinations and follow-up appointments.

In autoimmune and immune-mediated liver and biliary diseases, follow-up care may also include regular monitoring of liver function, disease activity, treatment effectiveness and possible complications.

Long-term care aims to achieve appropriate disease control, reduce the risk of organ damage and complications, and provide follow-up tailored to the patient’s condition.

How should you prepare for your first immunology consultation?

If available, please bring:

• previous laboratory results,
• immunological and autoantibody test results,
• liver function test results,
• previous specialist medical documentation,
• imaging reports,
• hospital discharge summaries,
• a list of medications you take regularly.

Reviewing these documents can help the specialist gain a more accurate understanding of how the symptoms developed and which investigations have already been performed.

Immunology clinic at SanBer Medical

Investigating autoimmune diseases is often a complex process. At the SanBer Medical immunology clinic, we aim to assess the patient’s symptoms, laboratory abnormalities, previous reports and possible organ involvement as parts of a complete clinical picture rather than as separate problems.

For patients with suspected autoimmune disease, we provide specialist consultations and recommendations for further investigation. For previously diagnosed autoimmune conditions, we offer follow-up examinations and long-term management.

We also place particular emphasis on the specialist assessment and follow-up of autoimmune and immune-mediated diseases of the liver and bile ducts.

Evidence-based assessment, personalised follow-up and patient-centred care at SanBer Medical.

Book an appointment for an immunology consultation.