Immune-mediated inflammatory diseases: IBD therapeutics

Question 1

What are examples of Immune-mediated inflammatory diseases?

Answer 1

Rheumatoid arthritis
Connective tissue disorders
Cutaneous inflammatory conditions (e.g. psoriasis and atopic dermatitis)
Inflammatory bowel disease (IBD)
Asthma
Autoimmune neurological diseases e.g. multiple sclerosis

Question 2

IBD refers to which two distinct intestinal conditions?

Answer 2

Crohn’s disease
Ulcerative colitis

Question 3

What is IBD?

Answer 3

Chronic inflammation of the gastric mucosa
Relapsing and remitting- unpredictable

Question 4

What area of the GI tract is affected by Crohn’s?

Answer 4

• Whole of the GI tract from mouth to anus can be affected.
• Transmural (all layers of the intestinal wall) ulceration
• Patchy

Question 5

What is ulcerative colitis?

Answer 5

Ulcerative colitis is a long-term condition where the colon and rectum become inflamed.

Question 6

Proctitis is inflammation of the

Answer 6

rectum

Question 7

Proctosigmoiditis is inflammation of the

Answer 7

rectum and sigmoid colon

Question 8

Pancolitis involves

Answer 8

entire colon is inflamed

Question 9

Name 3 potential risk factors of IBD

Answer 9

genetic
diet
smoking

Question 10

What are the symptoms of IBD?

Answer 10

Diarhoea
Abdominal pain
Tiredness and fatigue
Weightloss
Anaemia
Fever
Naseua

Question 11

What are the extra-intestinal signs and symptoms?

Answer 11

Swollen joints- arthritis
Eye problems- episcleritis, iritis, uveitis
Erythema nodosum- swollen fat under skin causing redness, bumps and lumps
Pyoderma gangrenosum- skin ulceration
Primary sclerosing cholangitis

Question 12

Strictures of Crohn’s disease

Answer 12

narrowed segments of bowel
lead to blockages, acute dilation, perforation

Question 13

What is a fistula?

Answer 13

small tunnel that forms at the end of the bowel and the skin near the anus

Question 14

What do IBD patients have increased risk of?

Answer 14

colorectal cancer

Question 15

What is faecal calprotectin?

Answer 15

very sensitive marker for inflammation in the GI tract

Question 16

What does faecal calprotectin distinguish between?

Answer 16

IBD and non-inflammatory causes e.g. IBS

Question 17

What is the Truelove and Witts’ severity index used to measure?

Answer 17

ulcerative colitis severity

Question 18

What is the CDAI?

Answer 18

Crohn’s disease activity index

Question 19

What are the primary aims of treatment for IBD?

Answer 19

achieving remission
maintaining remission
reducing complications
improving quality of life

Question 20

Rationale of corticosteroids in treating IBD?

Answer 20

induce disease remission- flares of UC and CD can be treated with corticosteroids

Question 21

How do corticosteroids work?

Answer 21

reduce inflammation and modulates immune system

Question 22

How does predinsolone work in IBD?

Answer 22

binds to cellular glucocorticoid receptors, inhibiting inflammatory cells and suppressing expression of inflammatory mediators

Question 23

Name 3 examples of corticosteorids that may be used to treat IBD?

Answer 23

Prednisolone, methylprednisolone, hydrocortisone

Question 24

What is co-prescribed with corticosteroids to protect the GI tract?

Answer 24

PPIs such as lansoprazole 15mg capsule OD this is stopped when patient completes their corticosteroid course

Question 25

Corticosteroids increase the risk of what in bones?

Answer 25

osteoporosis, patients taking corticosteroids should be prescribed a calcium and vitamin D supplement

Question 26

Explain the rationale for aminosalicylates

Answer 26

induction and maintenance of remission- mild-moderate ulcerative colitis

Question 27

How doe aminosalicylates work?

Answer 27

anti-inflammatory action- reduces inflammation in the GI tract through variety of anti-inflammatory processes

decreases prostaglandin production in the colon and inhibits production of pro-inflammatory cytokines

Question 28

What are the side effects of corticosteroids?

Answer 28

• GI effects
• fluid and electrolyte imbalance
• increased appetite
• hypertension
• effect on blood sugar
• mood and behaviour changes
• risk of osteoporosis
• must not be stopped abruptly (adrenal suppression)

Steroid treatment card
Steroid emergency card

Question 29

What medicines are co-prescribed with steroids?

Answer 29

Gastroprotection
PPIs e.g. omeprazole 20mg OD
Bone protection due to risk of osteoporosis calcium and vitamin supplement may be given

Question 30

How do aminosalicylates work?

Answer 30

anti-inflammatory action- reduces inflammation in the GI tract through variety of anti-inflammatory processes. Also decreases prostaglandin production in the colon and inhibits production of pro-inflammaotry cytokines.

Question 32

What immunomodulators are used for treatment of IBD?

Answer 32

Thiopurines
Methotrexate
Ciclosporin

Question 33

Name two examples of thiopurines?

Answer 33

Azathioprine and mercaptopurine

Question 34

What is the rationale of thiopurines?

Answer 34

First-line immunomodulators for IBD
Induce and maintain remission
can take 3-6 months for full effect

Question 35

Mechanism of action of thiopurines

Answer 35

reduces inflammation in GI tract
suppress immune response and inflammation
Metabolites have the capacity to impact on adaptive immune cells, innate immune cells and non-immune cells within the inflammed intestine