Involved in Determining susceptibility to Crohns Disease参与确定克罗恩病的易感因素课件.ppt

Fistulas: abnormal connections between intestines and another area of the body Strictures: narrowing of intestine Some patients may need to remove the enitre colon with or without the rectum * * DRUG THERAPY Non Rx treatment of acute symptoms Diarrhea, gas Acetaminophen for mild pain (not NSAIDS!) Supplements Rx treatment of flares and for remission Antibiotics Aminosalicylates Corticosteroids Mercaptopurine Monoclonal Antibodies AMINOSALICYLATES Mild to moderate CD Active form: 5-ASA - anti-inflammatory First line therapy due to lower side effects Ex. Mesalazine, Sulfalazine CORTICOSTEROIDS Moderate to severe CD Anti-inflammatory Suppress inflammatory genes that are activated in chronic inflammatory diseases by reversing histone acetylation, among other mechanisms Used sparingly due to side effects Reduce ability to fight infection* Ex. Prednisone, Budesonide MERCAPTOPURINE Remission: duration of action is months Purine analogs Exact mechanism unknown Interference with nucleic acid metabolism in immunological sequence that follows antigenic stimulation Ex. Azathioprine, 6-MP TNF-α INHIBITORS Severe CD – unresponsive to other treatments Biologic therapies: Monoclonal Antibodies Anti-TNF-α antibodies bind to TNF-α to prevent binding and activation of TNF receptors (neutralisation) Inactivation down regulates inflammatory reactions of autoimmune diseases May cause apoptosis of TNF-α expressing activated T cells Treatment of fistulising disease (closing maintenance of closure) inflammation ANTI-TNF-α MONOCLONAL ANTIBODIES Infliximab (Remicade) Mouse-human chimeric antibody IV ONLY (clinic/hospital) Adalimumab (HUMIRA) Fully human antibody Subcutaneous injection ONLY (self) SURGERY Reserved for complications or when disease that resists treatment is confined to one removable location (bowel resection) Complications requiring surgery may include Hemorrhage Fistulas Abscesses Strictures Colon cancer Summary Crohn’s Disease is characterized by inflammation, swelling