Immune-mediated inflammatory diseases: IBD therapeutics Flashcards
What are examples of Immune-mediated inflammatory diseases?
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
IBD refers to which two distinct intestinal conditions?
Crohn’s disease
Ulcerative colitis
What is IBD?
Chronic inflammation of the gastric mucosa
Relapsing and remitting- unpredictable
What area of the GI tract is affected by Crohn’s?
- Whole of the GI tract from mouth to anus can be affected.
- Transmural (all layers of the intestinal wall) ulceration
- Patchy
What is ulcerative colitis?
Ulcerative colitis is a long-term condition where the colon and rectum become inflamed.
Proctitis is inflammation of the
rectum
Proctosigmoiditis is inflammation of the
rectum and sigmoid colon
Pancolitis involves
entire colon is inflamed
Name 3 potential risk factors of IBD
genetic
diet
smoking
What are the symptoms of IBD?
Diarhoea
Abdominal pain
Tiredness and fatigue
Weightloss
Anaemia
Fever
Naseua
What are the extra-intestinal signs and symptoms?
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
Strictures of Crohn’s disease
narrowed segments of bowel
lead to blockages, acute dilation, perforation
What is a fistula?
small tunnel that forms at the end of the bowel and the skin near the anus
What do IBD patients have increased risk of?
colorectal cancer
What is faecal calprotectin?
very sensitive marker for inflammation in the GI tract
What does faecal calprotectin distinguish between?
IBD and non-inflammatory causes e.g. IBS
What is the Truelove and Witts’ severity index used to measure?
ulcerative colitis severity
What is the CDAI?
Crohn’s disease activity index
What are the primary aims of treatment for IBD?
achieving remission
maintaining remission
reducing complications
improving quality of life
Rationale of corticosteroids in treating IBD?
induce disease remission- flares of UC and CD can be treated with corticosteroids
How do corticosteroids work?
reduce inflammation and modulates immune system
How does predinsolone work in IBD?
binds to cellular glucocorticoid receptors, inhibiting inflammatory cells and suppressing expression of inflammatory mediators
Name 3 examples of corticosteorids that may be used to treat IBD?
Prednisolone, methylprednisolone, hydrocortisone
What is co-prescribed with corticosteroids to protect the GI tract?
PPIs such as lansoprazole 15mg capsule OD this is stopped when patient completes their corticosteroid course
Corticosteroids increase the risk of what in bones?
osteoporosis, patients taking corticosteroids should be prescribed a calcium and vitamin D supplement
Explain the rationale for aminosalicylates
induction and maintenance of remission- mild-moderate ulcerative colitis
How doe aminosalicylates work?
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
What are the side effects of corticosteroids?
- 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
What medicines are co-prescribed with steroids?
Gastroprotection
PPIs e.g. omeprazole 20mg OD
Bone protection due to risk of osteoporosis calcium and vitamin supplement may be given
How do aminosalicylates work?
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.
What immunomodulators are used for treatment of IBD?
Thiopurines
Methotrexate
Ciclosporin
Name two examples of thiopurines?
Azathioprine and mercaptopurine
What is the rationale of thiopurines?
First-line immunomodulators for IBD
Induce and maintain remission
can take 3-6 months for full effect
Mechanism of action of thiopurines
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
