Why can a patient with a chronic diagnosis appear asymptomatic on some days?

From the Guidelines

Fluctuations in symptoms are common in chronic illnesses, which explains why someone with a diagnosis of autoimmune hepatitis can appear normal on some days despite having a serious condition. This phenomenon occurs because disease progression isn't linear, and temporary improvements in energy, liver function, or other symptoms can create periods of apparent normalcy 1. The underlying condition, autoimmune hepatitis, continues to advance, but the body's natural compensatory mechanisms, effects of medications, or psychological factors can temporarily overcome physical limitations. According to the EASL clinical practice guidelines, up to a third of patients with autoimmune hepatitis have an insidious onset and gradual progression without apparent symptoms at diagnosis, and the final diagnosis is usually established during investigation for unexplained elevation of serum aminotransferases on routine testing 1. Some key points to consider include:

• The presence of subclinical disease, which can precede the onset of symptoms and may also occur after presentation, making diagnosis challenging 1
• The importance of liver biopsy in establishing the diagnosis and assessing the extent of liver damage
• The potential for variability in symptoms, even in advanced disease, due to factors such as the pattern of autoantibodies detected and the presence of cirrhosis 1 It's essential for patients and their loved ones to understand that these good days don't necessarily indicate recovery but are natural variations in the disease course, and making the most of these better days while preparing for the overall decline is crucial for maintaining quality of life.

From the Research

Multiple Sclerosis Diagnosis and Symptoms

• Multiple sclerosis (MS) is a chronic inflammatory autoimmune demyelinating disease that can lead to axonal loss and brain atrophy 2.
• The disease is characterized by an abnormal immune response, with T cells and B lymphocytes playing a key role in its development 3.
• MS can present with a wide range of symptoms, and its progression can be highly variable, making diagnosis and treatment challenging.

Variability in Symptoms and Disease Progression

• The symptoms of MS can vary significantly from one day to another, and even from one hour to another, due to the unpredictable nature of the disease 4.
• Some days, individuals with MS may appear completely normal, while on other days, they may experience severe symptoms such as relapses or exacerbations 5.
• The disease-modifying therapies (DMTs) used to treat MS, such as interferon beta and glatiramer acetate, can help reduce the frequency and severity of relapses, but they may not completely eliminate symptoms 6, 4.

Disease-Modifying Therapies and Their Effects

• Interferon beta and glatiramer acetate are two commonly used DMTs for the treatment of relapsing-remitting MS 6, 4.
• These therapies have been shown to be effective in reducing the frequency and severity of relapses, as well as slowing down disease progression 5.
• However, the effects of these therapies can vary from person to person, and some individuals may experience more benefits than others 2, 3.
• The choice of DMT should be based on the individual's specific needs and circumstances, taking into account factors such as disease severity, medical history, and lifestyle 4, 5.