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Crohn’s Disease

What is Crohn’s Disease?

Specialist checking kid’s pulse with stethoscope; specialist’s office scene

Crohn’s infection is a fiery inside illness that causes constant iArritation of the gastrointestinal plot. ​If you have been determined to have Crohn’s illness or are searching for more data about the condition, we are here to help.

Living with an ongoing sickness can be upsetting and overpowering. We can give you data and assets to assist you with dealing with the physical and enthusiastic side effects of Crohn’s illness.

Crohn’s illness is a kind of provocative gut infection (IBD). It causes irritation of your stomach related parcel, which can prompt stomach torment, extreme looseness of the bowels, weakness, weight reduction and unhealthiness.

Aggravation brought about by Crohn’s infection can include various territories of the stomach related parcel in various individuals. This irritation regularly spreads into the more profound layers of the gut.

Crohn’s infection can be both difficult and incapacitating, and here and there may prompt dangerous inconveniences.

While there’s no known solution for Crohn’s sickness, treatments can extraordinarily lessen its signs and side effects and in any event, achieve long haul reduction and mending of irritation. With treatment, numerous individuals with Crohn’s infection can work well.

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Book: Mayo Clinic on Digestive Health

Side effects

Stomach related framework

Stomach related systemOpen spring up exchange box

In Crohn’s infection, any piece of your little or internal organ can be included, and it very well might be constant or may include different sections. In certain individuals, the infection is kept to the colon, which is important for the internal organ.

Signs and indications of Crohn’s infection can go from mellow to serious. They typically grow continuously, however some of the time will come on out of nowhere, all of a sudden. You may likewise have timeframes when you have no signs or indications (abatement).

At the point when the sickness is dynamic, signs and side effects may include:

Looseness of the bowels

Fever

Weariness

Stomach torment and squeezing

Blood in your stool

Mouth injuries

Diminished hunger and weight reduction

Torment or seepage close or around the rear-end because of irritation from a passage into the skin (fistula)

Different signs and side effects

Individuals with extreme Crohn’s illness may likewise insight:

Irritation of skin, eyes and joints

Irritation of the liver or bile pipes

Kidney stones

Iron inadequacy (paleness)

Deferred development or sexual turn of events, in youngsters

When to see a specialist

See your PCP in the event that you have tenacious changes in your entrail propensities or on the off chance that you have any of the signs and manifestations of Crohn’s infection, for example,

Stomach torment

Blood in your stool

Sickness and heaving

Continuous episodes of loose bowels that don’t react to over-the-counter (OTC) prescriptions

Unexplained fever enduring over a day or two

Unexplained weight reduction

More Information

Crohn’s infection care at Mayo Clinic

Crohn’s infection side effect: Is exhaustion normal?

Solicitation an Appointment at Mayo Clinic

Causes

The specific reason for Crohn’s infection stays obscure. Beforehand, diet and stress were suspected, however now specialists realize that these variables may exasperate, yet don’t cause, Crohn’s illness. A few variables, for example, heredity and a failing insusceptible framework, likely assume a part in its turn of events.

Safe framework. It’s conceivable that an infection or bacterium may trigger Crohn’s illness; notwithstanding, researchers still can’t seem to recognize quite a trigger. At the point when your insusceptible framework attempts to ward off the attacking microorganism, an unusual resistant reaction makes the invulnerable framework assault the cells in the stomach related parcel, as well.

Heredity. Crohn’s is more normal in individuals who have relatives with the illness, so qualities may assume a function in creation individuals more powerless. Nonetheless, a great many people with Crohn’s infection don’t have a family background of the illness.

Danger factors

Danger factors for Crohn’s infection may include:

Age. Crohn’s infection can happen at whatever stage in life, however you’re probably going to build up the condition when you’re youthful. A great many people who build up Crohn’s infection are analyzed before they’re around 30 years of age.

Identity. Despite the fact that Crohn’s sickness can influence any ethnic gathering, whites have the most elevated danger, particularly individuals of Eastern European (Ashkenazi) Jewish plunge. In any case, the occurrence of Crohn’s infection is expanding among Black individuals who live in North America and the United Kingdom.

Family ancestry. You’re at higher danger in the event that you have a first-degree relative, for example, a parent, kin or kid, with the infection. Upwards of 1 out of 5 individuals with Crohn’s infection has a relative with the illness.

Cigarette smoking. Cigarette smoking is the main controllable danger factor for building up Crohn’s infection. Smoking likewise prompts more-serious infection and a more serious danger of having a medical procedure. On the off chance that you smoke, it’s imperative to stop.

Nonsteroidal mitigating prescriptions. These incorporate ibuprofen (Advil, Motrin IB, others), naproxen sodium (Aleve), diclofenac sodium and others. While they don’t cause Crohn’s sickness, they can prompt aggravation of the inside that exacerbates Crohn’s.

Inconveniences

Crohn’s sickness may prompt at least one of the accompanying difficulties:

Entrail block. Crohn’s illness can influence the whole thickness of the intestinal divider. Over the long haul, portions of the entrail can scar and limited, which may impede the progression of stomach related substance. You may expect a medical procedure to eliminate the ailing segment of your entrail.

Ulcers. Ongoing aggravation can prompt open injuries (ulcers) anyplace in your stomach related lot, including your mouth and rear-end, and in the genital zone (perineum).

Fistulas. Some of the time ulcers can expand totally through the intestinal divider, making a fistula — an anomalous association between various body parts. Fistulas can create between your digestive tract and your skin, or between your digestive system and another organ. Fistulas close or around the butt-centric zone (perianal) are the most widely recognized kind.

At the point when fistulas create in the midsection, food may sidestep zones of the gut that are essential for assimilation. Fistulas may shape between circles of gut, in the bladder or vagina, or through the skin, causing nonstop waste of gut substance to your skin.

Sometimes, a fistula may get contaminated and structure a sore, which can be dangerous if not treated.

Butt-centric crevice. This is a little tear in the tissue that lines the rear-end or in the skin around the butt where contaminations can happen. It’s regularly connected with excruciating defecations and may prompt a perianal fistula.

Unhealthiness. Loose bowels, stomach agony and squeezing may make it hard for you to eat or for your digestive tract to ingest enough supplements to keep you fed. It’s likewise regular to create weakness because of low iron or nutrient B-12 brought about by the sickness.

Colon disease. Having Crohn’s sickness that influences your colon expands your danger of colon disease. General colon malignant growth screening rules for individuals without Crohn’s illness require a colonoscopy like clockwork starting at age 50. Find out if you need to have this test done sooner and all the more much of the time.

Other medical issues. Crohn’s sickness can mess up different pieces of the body. Among these issues are paleness, skin problems, osteoporosis, joint inflammation, and gallbladder or liver sickness.

Drug chances. Certain Crohn’s infection sedates that demonstration by hindering elements of the resistant framework are related with a little danger of creating tumors, for example, lymphoma and skin diseases. They additionally increment danger of contamination.

Corticosteroids can be related with a danger of osteoporosis, bone breaks, waterfalls, glaucoma, diabetes and hypertension, among different conditions. Work with your PCP to decide dangers and advantages of drugs.

Blood clusters. Crohn’s illness expands the danger of blood clusters in veins and courses.

What is Crohn’s illness?

Crohn’s infection, additionally called local enteritis or ileitis, is a deep rooted type of provocative gut sickness (IBD). The condition arouses and disturbs the stomach related plot — explicitly the little and internal organs. Crohn’s sickness can cause the runs and stomach cramps. It’s entirely expected to encounter occasional illness flare-ups.

Crohn’s illness gets its name from American gastroenterologist Dr. Burrill Crohn (1884-1983). He was one of the primary doctors to depict the sickness in 1932. Ulcerative colitis is another generally analyzed IBD.

How normal is Crohn’s illness?

An expected a large portion of 1,000,000 Americans have Crohn’s infection. This can incorporate men, ladies and youngsters.

Who may get Crohn’s infection?

Crohn’s infection regularly shows up in more youthful individuals – frequently in their late adolescents, 20s or mid 30s. Nonetheless, this condition can occur at whatever stage in life. It’s similarly basic in people. Crohn’s infection can likewise be find in little youngsters.

In case you’re a cigarette smoker, your danger of Crohn’s sickness may be higher than non-smokers.

What are the sorts of Crohn’s illness?

Crohn’s sickness can influence various segments of the stomach related plot. Sorts of Crohn’s illness include:

Ileocolitis: Inflammation happens in the small digestive system and part of the internal organ, or colon. Ileocolitis is the most widely recognized kind of Crohn’s sickness.

Ileitis: Swelling and aggravation create in the small digestive system (ileum).

Gastroduodenal: Inflammation and bothering influence the stomach and the highest point of the small digestive system (the duodenum).

Jejunoileitis: Patchy regions of irritation create in the upper portion of the small digestive tract (called the jejunum).

What causes Crohn’s sickness?

There’s no known reason for Crohn’s infection. Certain variables may expand your danger of building up the condition, including:

Immune system infection: Bacteria in the stomach related lot may make the body’s resistant framework assault your sound cells.

Qualities: Inflammatory entrail infection (IBD) frequently runs in families. On the off chance that you have a parent, kin or other relative with Crohn’s, you might be at an expanded danger of likewise having it. There are a few explicit transformations (changes) to your qualities that can incline individuals to building up Crohn’s sickness.

Smoking: Cigarette smoking could as much as twofold your danger of Crohn’s sickness.

What are the manifestations of Crohn’s infection?

Individuals with Crohn’s infection can encounter times of serious indications (flare-ups) trailed by times of no or exceptionally mellow manifestations (abatement). Reduction can a weeks ago or even years. It is extremely unlikely to anticipate when erupt ups will occur.

On the off chance that you have Crohn’s infection, manifestations you may have can include:

Stomach torment.

Persistent loose bowels.

A sensation of totality.

Fever.

A deficiency of your hunger.

Weight reduction.

Irregular skin labels (normally on your hindquarters).

Butt-centric gaps.

Butt-centric fistulas.

Rectal dying.

Crohn’s disease is a chronic inflammatory disease of the gastrointestinal (digestive, GI) tract.
Symptoms of Crohn’s disease include:
Abdominal pain
Diarrhea
Vomiting
Fever
Bloody diarrhea
Anal fistulae
Perirectal abscesses
Weight loss
The cause of Crohn’s disease is unknown.
Crohn’s disease is not contagious. You cannot “get” it from another person.
Diet can affect and trigger Crohn’s disease flare-ups; however, it is doubtful that diet causes the disease.
Researchers and doctors do not know the cause of Crohn’s disease; however, some suspect that the cause is due to certain bacteria, for example, mycobacterium.
Crohn’s disease can cause ulcers in the small intestine, colon, or both. The disease also may cause obstruction of the small intestine.
Associated sign and symptoms of Crohn’s disease include reddish, tender skin nodules, and inflammation of the joints, spine, eyes, and liver.
Crohn’s disease and ulcerative colitis (another chronic inflammatory condition of the colon) are a type of inflammatory bowel disease (IBD).
The diagnosis of Crohn’s disease is made by barium enema, barium X-ray of the small bowel, and colonoscopy.
The choice of treatment for Crohn’s disease depends on the location and severity of the disease.
Treatment of Crohn’s disease includes 5-ASA compounds and corticosteroids, topical antibiotics, immunomodulators, and biosimilars drugs for suppressing inflammation or the immune system; antibiotics, and surgery.
Complications of Crohn’s disease include megacolon and rupture of the intestine, painful eye conditions, arthritis, inflammation of the low back and spine, hepatitis, cirrhosis, jaundice, and cancer.
Inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS) are two different problems with the digestive tract (gastrointestinal, GI).
Is Crohn’s Disease Contagious?
Crohn’s disease is not contagious. It is a chronic inflammatory disease of the bowels, mainly involving the small and large intestines. Researchers and doctors do not know what causes Crohn’s, but they suspect that there are are genetic, immunologic, environmental, dietary, vascular, microbial, and even psycho-social factors that play roles in triggering or aggravating the Crohn’s disease.

Click for more about how you get Crohn’s disease »

What is Crohn’s disease?
Picture of the areas affected by Crohn’s disease.
Picture of the areas affected by Crohn’s disease.
Crohn’s disease (sometimes called Crohn disease) is a chronic inflammatory disease of the intestines. It primarily causes ulcerations (breaks in the mucosal lining) of the small and large intestines, but can affect the digestive system anywhere from the mouth to the anus. It is named after the physician who described the disease in 1932. It also is called granulomatous enteritis or colitis, regional enteritis, ileitis, or terminal ileitis.

Crohn’s disease is related closely to another chronic inflammatory condition that involves only the colon called ulcerative colitis. Together, Crohn’s disease and ulcerative colitis are referred to as inflammatory bowel disease (IBD). Ulcerative colitis and Crohn’s disease have no medical cure. Once the diseases begin, they tend to fluctuate between periods of inactivity (remission) and activity (relapse).

Men and women are affected equally by inflammatory bowel disease. Americans of Jewish European descent are more likely to develop IBD than the general population. IBD has historically been considered predominately a disease of Caucasians, but there has been an increase in the reported cases in African Americans. The prevalence appears to be lower among Hispanic and Asian populations. IBD most commonly begins during adolescence and early adulthood (usually between the ages of 15 and 35). There is a small second peak of newly diagnosed cases after age 50. The number of new cases (incidence) and number of cases (prevalence) of Crohn’s disease in the United States are rising, although the reason for this is not completely understood.

Crohn’s disease tends to be more common in relatives of patients with Crohn’s disease. If a person has a relative with the disease, his/her risk of developing the disease is estimated to be at least 10 times that of the general population and 30 times greater if the relative with Crohn’s disease is a sibling. It also is more common among relatives of patients with ulcerative colitis.

QUESTION
What is Crohn’s disease?
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What are the types, symptoms, and signs of Crohn’s disease?
Readers Comments 46 Share Your Story
Common symptoms of Crohn’s disease include abdominal pain, diarrhea, and weight loss. Less common symptoms include

poor appetite,
fever,
night sweats,
rectal pain, and
occasionally rectal bleeding.
The symptoms of Crohn’s disease are dependent on the location, the extent, and the severity of the inflammation. The different subtypes of Crohn’s disease and their symptoms are:

Crohn’s colitis is inflammation that is confined to the colon. Abdominal pain and bloody diarrhea are the common symptoms. Anal fistulae and perirectal abscesses also can occur.
Crohn’s enteritis refers to inflammation confined to the small intestine (the second part, called the jejunum or the third part, called the ileum). Involvement of the ileum alone is referred to as Crohn’s ileitis. Abdominal pain and diarrhea are the common symptoms. Obstruction of the small intestine also can occur.
Crohn’s terminal ileitis is inflammation that affects only the very end of the small intestine (terminal ileum), the part of the small intestine closest to the colon. Abdominal pain and diarrhea are the common symptoms. Small intestinal obstruction also can occur.
Crohn’s enterocolitis and ileocolitis are terms to describe inflammation that involve both the small intestine and the colon. Bloody diarrhea and abdominal pain are the common symptoms. Small intestinal obstruction also can occur.
Crohn’s terminal ileitis and ileocolitis are the most common types of Crohn’s disease. (Ulcerative colitis frequently involves only the rectum or rectum and sigmoid colon at the distal end of the colon. These are called ulcerative proctitis and procto-sigmoiditis, respectively.)
Up to one-third of patients with Crohn’s disease may have one or more of these conditions, symptoms, and signs that involve the anal area affected.

Swelling of the tissue of the anal sphincter, the muscle at the end of the colon that controls defecation.
Development of ulcers and fissures (long ulcers) within the anal sphincter. These ulcers and fissures can cause bleeding and pain with defecation.
Development of anal fistulae (abnormal tunnels) between the anus or rectum and the skin surrounding the anus). Mucous and pus may drain from the openings of the fistulae on the skin.
Development of perirectal abscesses (collections of pus in the anal and rectal area). Peri-rectal abscesses can cause fever, pain and tenderness around the anus.
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What causes Crohn’s disease?
The cause of Crohn’s disease is unknown. Some scientists suspect that infection by certain bacteria, such as strains of mycobacterium, may be the cause of Crohn’s disease. Crohn’s disease is not contagious. Diet may affect the symptoms of Crohn’s disease; however, it is unlikely that diet is responsible for causing the disease.

Activation of the immune system in the intestines appears to be important in IBD. The immune system is composed of immune cells and the proteins that these immune cells produce. Normally, these cells and proteins defend the body against harmful bacteria, viruses, fungi, and other foreign invaders. Activation of the immune system causes inflammation within the tissues where the activation occurs. (Inflammation is an important mechanism of defense used by the immune system.)

Normally, the immune system is activated only when the body is exposed to harmful invaders. In individuals with IBD the immune system is abnormally and chronically activated in the absence of any known invader. This results in chronic inflammation and ulceration. The susceptibility to abnormal activation of the immune system is genetically inherited. Thus, first degree relatives (brothers, sisters, children, and parents) of people with IBD are more likely to develop these diseases. Recently a gene called NOD2 has been identified as being associated with Crohn’s disease. This gene is important in determining how the body responds to some bacterial products. Individuals with mutations in this gene are more susceptible to developing Crohn’s disease.

Other genes are still being discovered and studied which are important in understanding the pathogenesis of Crohn’s disease including autophagy related 16-like 1 gene (ATG 16L1) and IRGM, which both contribute to macrophage defects and have been identified with the Genome-Wide Association study. There also have been studies which show that in the intestines of individuals with Crohn’s disease, there are higher levels of a certain type of bacterium, E. coli, which might play a role in the disease. One postulated mechanism by which this could occur is through a genetically determined defect in the elimination of the E. coli, by intestinal mucosal macrophages. The exact roles that these various factors play in the development of this disease remain unclear.

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Crohn’s Disease: Symptoms, Causes, Diet
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What are the differences between Crohn’s disease and ulcerative colitis?
While ulcerative colitis causes inflammation only in the colon (colitis) and/or the rectum (proctitis), Crohn’s disease may cause inflammation in the colon, rectum, small intestine (jejunum and ileum), and, occasionally, even the stomach, mouth, and esophagus.

The patterns of inflammation in Crohn’s disease are different from ulcerative colitis. Except in the most severe cases, the inflammation of ulcerative colitis tends to involve the superficial layers of the inner lining of the bowel. The inflammation also tends to be diffuse and uniform (all of the lining in the affected segment of the intestine is inflamed).

Unlike ulcerative colitis, the inflammation of Crohn’s disease is concentrated in some areas more than others, and involves layers of the bowel that are deeper than the superficial inner layers. The affected segment(s) of bowel in Crohn’s disease often is studded with deeper ulcers with normal lining between these ulcers.

How does Crohn’s disease affect the intestines?
Picture of the organs and glands in the abodmen
Picture of the organs and glands in the abdomen
In the early stages, Crohn’s disease causes small, scattered, shallow, crater-like ulcerations (erosions) on the inner surface of the bowel. These erosions are called aphthous ulcers. With time, the erosions become deeper and larger, ultimately becoming true ulcers (which are deeper than erosions), and causing scarring and stiffness of the bowel. As the disease progresses, the bowel becomes increasingly narrowed, and ultimately can become obstructed. Deep ulcers can cause puncture holes or perforations in the wall of the bowel, and bacteria from within the bowel can spread to infect adjacent organs and the surrounding abdominal cavity.

When Crohn’s disease narrows the small intestine to the point of obstruction, the flow of the contents through the intestine ceases. Sometimes, the obstruction can be caused suddenly by poorly digestible fruit or vegetable matter that plug the already-narrowed segment of the intestine. When the intestine is obstructed, food, fluid and gas from the stomach and the small intestine cannot pass into the colon. The symptoms of small intestinal obstruction then appear, including severe abdominal cramps, nausea, vomiting, and abdominal distention. Obstruction of the small intestine is much more likely since the small intestine is much narrower than the colon.

Deep ulcers can cause puncture holes or perforations in the walls of the small intestine and the colon, and create a tunnel between the intestine and adjacent organs. If the ulcer tunnel reaches an adjacent empty space inside the abdominal cavity, a collection of infected pus (an abdominal abscess) is formed. Individuals with abdominal abscesses can develop tender abdominal masses, high fevers, and abdominal pain.

When the ulcer tunnels into an adjacent organ, a channel (fistula) is formed.
The formation of a fistula between the intestine and the bladder (enteric-vesicular fistula) can cause frequent urinary tract infections and the passage of gas and feces during urination.
When a fistula develops between the intestine and the skin (enteric-cutaneous fistula), pus and mucous emerge from a small painful opening on the skin of the abdomen.
The development of a fistula between the colon and the vagina (colonic-vaginal fistula) causes gas and feces to emerge through the vagina.
The presence of a fistula from the intestines to the anus (anal fistula) leads to a discharge of mucous and pus from the fistula’s opening around the anus.
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What procedures and tests diagnose Crohn’s disease?
There is no specific diagnostic test for Crohn’s disease. The diagnosis of Crohn’s disease is suspected in patients with fever, abdominal pain and tenderness, diarrhea with or without bleeding, and anal diseases, such as ulcers or fissures.

Laboratory blood tests may show elevated white blood cell counts and sedimentation rates, both of which suggest infection or inflammation. Other blood tests may show low red blood cell counts (anemia), low blood proteins, and low body minerals, reflecting loss of these minerals due to chronic diarrhea.

Barium X-ray studies can be used to define the distribution, nature, and severity of the disease. Barium is a chalky material that is visible by X-ray and appears white on X-ray films. When barium is ingested orally (upper GI series) it fills the intestine, and pictures (X-rays) can be taken of the stomach and the small intestines. When barium is administered through the rectum (barium enema), pictures of the colon and the terminal ileum can be obtained. Barium X-rays can show ulcerations, narrowing, and, sometimes, fistulae of the bowel.

Direct visualization of the rectum and the large intestine can be accomplished with flexible viewing tubes (colonoscopes). Colonoscopy is more accurate than barium X-rays in detecting small ulcers or small areas of inflammation of the colon and terminal ileum. Colonoscopy also allows for small tissue samples (biopsies) to be taken and sent for examination under the microscope to confirm the diagnosis of Crohn’s disease. Colonoscopy also is more accurate than barium X-rays in assessing the degree (activity) of inflammation.

Computerized axial tomography (CAT or CT) scanning is a computerized X-ray technique that allows imaging of the entire abdomen and pelvis. It can be especially helpful in detecting abscesses. CT and MRI enterography are imaging techniques which use oral contrast agents consisting of watery solutions with or without low concentrations of barium to provide more adequate luminal distension, have been reported to be superior in the evaluation of small bowel pathology in patients with Crohn’s disease.

Video capsule endoscopy (VCE) has also been added to the list of tests for diagnosing Crohn’s disease. For video capsule endoscopy, a capsule containing a miniature video camera is swallowed. As the capsule travels through the small intestine, it sends video images of the lining of the small intestine to a receiver carried on a belt at the waist. The images are downloaded and then reviewed on a computer. The value of video capsule endoscopy is that it can identify the early, mild abnormalities of Crohn’s disease. Video capsule endoscopy may be particularly useful when there is a strong suspicion of Crohn’s disease but the barium X-rays are normal. (Barium X-rays are not as good at identifying early, mild Crohn’s disease.) In a prospective blinded evaluation, video capsule endoscopy was demonstrated to be superior in its ability to detect small bowel pathology missed on small bowel radiographic studies and CT exams.

Video capsule endoscopy should not be performed in patients who have an obstruction of the small intestine. The capsule may become stuck at the site of obstruction and make the obstruction worse. Doctors usually also are reluctant to perform video-capsule endoscopy for the same reason in patients whom they suspect of having small intestinal strictures (narrowed segments of small intestine that can result from prior surgery, prior radiation, or chronic ulceration, for example, from Crohn’s disease). There is also a theoretical concern for electrical interference between the capsule and implanted cardiac pacemakers and defibrillators; however, so far in a small-moderate number of patients with pacemakers or defibrillators who have undergone video capsule endoscopy, there have been no problems.

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Is there a Crohn’s disease diet plan, and what vaccinations are recommended?
Readers Comments 28 Share Your Story
Dietary changes and supplementation that may help control Crohn’s disease
Since fiber is poorly digestible, it can worsen the symptoms of intestinal obstruction. A low fiber diet for Crohn’s diease may be recommended, especially in those patients with small intestinal disease.
A liquid diet may be of benefit when symptoms are more severe.
Intravenous nutrition or TPN (total parenteral nutrition) may be utilized when it is felt that the intestine needs to “rest.”
Supplementation of calcium, folate and vitamin B12 is helpful when malabsorption of these nutrients is apparent.
The use of anti-diarrheal agents (diphenoxylate and atropine [Lomotil], loperamide [Imodium]) and antispasmodics also can help relieve symptoms of cramps and diarrhea.
Vaccination recommendations for individuals with Crohn’s disease
Adults with inflammatory bowel disease generally should follow the same vaccination schedules as the general population.
They should receive a single dose of Tdap, then Td booster every 10 years.
Women between the ages of 9 and 26 should receive 3 doses of HPV vaccine (and consideration should be given to older patients who are HPV negative on Pap smear). Men in the same age range should also consider being vaccinated given the increased risk of HPV with immunosuppression.
The influenza (flu) vaccine should be given annually to all patients (though the live intranasal vaccine is contraindicated in patients on immunosuppressive therapy).
One dose of pneumococcal vaccine should be given between age 19-26 and then revaccination after 5 years.
If not previously vaccinated, all adults should receive 2 doses of hepatitis A vaccine and 3 doses of hepatitis B.
Meningococcal vaccine is only recommended for patients with anatomic or functional asplenia, terminal complement deficiencies, or others at higher risk (college students, military recruits, etc.).
Mumps/measles/rubella, varicella, and zoster vaccines are contraindicated for patients on biologic therapy, as they are all live vaccines.
Other factors that may affect Crohn’s disease

A study found that smoking is a risk factor for Crohn’s disease, and secondhand smoke also can contribute to a worse prognosis. Quitting smoking should be advised to patients with Crohn’s disease.

Osteoporosis with markedly reduced bone mineral densities has also increasingly been recognized as a significant health problem in patients with inflammatory bowel disease. Screening with a bone density study is recommended in postmenopausal woman, men over age 50, patients with prolonged corticosteroid use (more than 3 consecutive months or recurrent courses), patients with personal history of traumatic fractures with minimal trauma, and patients with hypogonadism. Most patients with inflammatory bowel disease should be taking calcium and vitamin D supplements.

What medications, vitamins, and supplements treat and manage Crohn’s disease?
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There is no medication that can cure Crohn’s disease.

Patients with Crohn’s disease typically will experience flares, or periods of relapse (worsening of inflammation) followed by periods of remission (lessening of inflammation) lasting months to years.
During relapses, symptoms of abdominal pain, diarrhea, and rectal bleeding worsen.
During remissions, these symptoms improve. Remissions usually occur because of treatment with medications or surgery, but occasionally they occur spontaneously without any treatment.
Since there is no cure for Crohn’s disease, the goals of treatment are to 1) induce remissions, 2) maintain remissions, 3) minimize the side effects of treatment, and 4) improve the quality of life. Treatment of Crohn’s disease and ulcerative colitis with medications is similar though not always identical.
Anti-inflammatory agents such as 5-ASA compounds and corticosteroids, topical antibiotics, immunomodulators, and biosimilars are medications used to treat Crohn’s disease.
Selection of treatment regimens depends on disease severity, disease location, and disease-associated complications.
Various treatment guidelines recommend that approaches be sequential — initially to induce clinical remission, and then to maintain remissions. Initial evidence of improvement should be seen within 2 to 4 weeks, and maximal improvement should be seen in 12 to 16 weeks. The classic approach to therapy in Crohn’s disease has been a “step-up” approach starting with the least toxic agents for mild disease, and increasingly more aggressive treatment for more severe disease, or patients who have not responded to less toxic agents.
Treatment has been moving toward a “top-down” approach (early aggressive management) which might decrease exposure to anti-inflammatory agents and increase exposure to agents that enhance mucosal healing that might prevent future complications.

What are anti-inflammatory medications and their side effects?
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Anti-inflammatory medications that decrease intestinal inflammation are similar to arthritis medications that decrease joint inflammation. Examples of types of anti-inflammatory medications used in the treatment of Crohn’s disease are:

5 aminosalicylic acid (5-ASA) compounds, for example, sulfasalazine (Azulfidine) and mesalamine (Pentasa, Asacol, Dipentum, Colazal, Rowasa enema, Canasa suppository).
Corticosteroids that act systemically (without the need for direct contact with the inflamed tissue) to decrease inflammation throughout the body. Systemic corticosteroids have important and predictable side effects if used long-term.
Topical corticosteroids, for example, budesonide (Entocort EC). This class of corticosteroids has fewer side effects than systemic corticosteroids, which are absorbed into the body.
Antibiotics that decrease inflammation, for example, metronidazole (Flagyl) and ciprofloxacin (Cipro).

What are 5-ASA oral and rectal medications and their side effects?
5-aminosalicylic acid (5-ASA), also called mesalamine, is similar chemically to aspirin. Aspirin is an anti-inflammatory drug that has been used for many years for treating arthritis, bursitis, and tendonitis (conditions of tissue inflammation). Aspirin, however, is not effective in treating Crohn’s disease and ulcerative colitis and may even worsen the inflammation. Recent studies suggest that aspirin might actually decrease future risk of developing colorectal cancer in the general population.

On the other hand, 5-ASA can be effective in treating Crohn’s disease and ulcerative colitis if the drug can be delivered topically onto the inflamed intestinal lining. For example, mesalamine (Rowasa) is an enema containing 5-ASA that is effective in treating inflammation in the rectum. However, the enema solution cannot reach high enough to treat inflammation in the upper colon and the small intestine. Therefore, most patients with Crohn’s disease involving both the ileum (distal small intestine) and colon, must take 5-ASA orally.

If pure 5-ASA is taken orally, however, most of the 5-ASA would be absorbed in the stomach and the upper small intestine, and very little 5-ASA would reach the ileum and colon. To be effective as an oral agent in treating Crohn’s disease, 5-ASA has to be modified chemically to escape absorption by the stomach and the upper intestines.

Sulfasalazine (Azulfidine)
Sulfasalazine (Azulfidine) was the first modified 5-ASA compound used in the treatment of Crohn’s colitis and ulcerative colitis. It has been used successfully for many years to induce remissions among patients with mild to moderate ulcerative colitis. Sulfasalazine also has been used for prolonged periods for maintaining remissions.

Most of the side effects of sulfasalazine include nausea, heartburn, headache, anemia, skin rashes, and, in rare instances, hepatitis and kidney inflammation. In men, sulfasalazine can reduce the sperm count. The reduction in sperm count is reversible, and the count usually becomes normal after the sulfasalazine is discontinued or changed to a different 5- ASA compound.

Some 5-ASA compounds, for example, mesalamine (Asacol and Pentasa), do not have the sulfapyridine component and have fewer side effects than sulfasalazine, and are used more frequently for treating Crohn’s disease and ulcerative colitis.

Mesalamine (Asacol)
Asacol is effective in inducing remissions in patients with mild to moderate ulcerative colitis. It also is effective when used in the longer term to maintain remissions. Some studies have shown that Asacol also is effective in treating Crohn’s ileitis and ileo-colitis, as well as in maintaining remission in patients with Crohn’s disease.

Mesalamine (Pentasa)
Pentasa is a capsule consisting of small spheres containing 5-ASA. Pentasa is sulfa-free. As the capsule travels down the intestines, the 5-ASA inside the spheres is released slowly into the intestine. Unlike Asacol, the active drug 5-ASA in Pentasa is released into the small intestine as well as the colon. Pentasa can be effective in treating inflammation in the small intestine and is currently the most commonly used 5-ASA compound for treating mild to moderate Crohn’s disease in the small intestine.

Patients with Crohn’s disease occasionally undergo surgery to relieve small intestinal obstruction, drain abscesses, or remove fistulae. Usually, the diseased portions of the intestines are removed during surgery. After successful surgery, patients can be free of disease and symptoms (in remission) for a while. In many patients, however, Crohn’s disease eventually returns. Pentasa helps maintain remissions and reduces the chances of the recurrence of Crohn’s disease after surgery.

Olsalazine (Dipentum)
Olsalazine (Dipentum) is a capsule filled with a drug in which two molecules of 5-ASA are joined together by a chemical bond. In this form, the 5-ASA cannot be absorbed from the stomach and intestine. Intestinal bacteria are able to break apart the two molecules releasing the active individual 5-ASA molecules into the intestine. Since intestinal bacteria are more abundant in the ileum and colon, most of the active 5-ASA is released in these areas. Therefore, olsalazine is most effective for disease that is limited to the ileum or colon. Although clinical studies have shown that olsalazine is effective for maintenance of remission in ulcerative colitis, some patients experience diarrhea when taking olsalazine. Because of this, olsalazine is not often used.

Balsalazide (Colazal)
Balsalazide (Colazal) is a capsule in which the 5-ASA is linked by a chemical bond to another molecule that is inert (without an effect on the intestine) and prevents the 5-ASA from being absorbed. This drug is able to travel through the intestine unchanged until it reaches the end of the small bowel (terminal ileum) and colon. There, intestinal bacteria split the 5-ASA and the inert molecule releasing the 5-ASA. Because intestinal bacteria are most abundant in the terminal ileum and colon, balsalazide is used to treat inflammation predominantly localized to the colon.

Side effects of oral 5-ASA compounds
The 5-ASA compounds have fewer side effects than Azulfidine and do not reduce sperm counts. They are safe medications for long-term use and are well-tolerated.
Patients allergic to aspirin should avoid 5-ASA compounds because they are similar chemically to aspirin.
Rarely, kidney and lung inflammation has been reported with the use of 5-ASA compounds. 5-ASA should be used with caution in patients with kidney disease. It also is recommended that blood tests of kidney function be done before starting and periodically during treatment.
Rare instances of worsening of diarrhea, cramps, and abdominal pain, at times accompanied by fever, rash, and malaise, may occur. This reaction is believed to represent an allergy to the 5-ASA compound.

What are 5-ASA rectal medications (Rowasa, Canasa) and their side effects?
Rowasa is 5-ASA in enema form and is used in treating Crohn’s disease in which there is inflammation in and near the rectum. The enema usually is administered at bedtime, and patients are encouraged to retain the enema through the night. The enema contains sulfite and should not be used by patients with sulfite allergy. Otherwise, Rowasa enemas are safe and well tolerated.

Both enemas and suppositories have been shown to be effective in maintaining remission in patients with ulcerative colitis limited to the distal colon and rectum.

What are corticosteroids and their side effects?
Corticosteroids (for example, prednisone, prednisolone, hydrocortisone, etc.) have been used for many years to treat patients with moderate to severe Crohn’s disease and ulcerative colitis and to treat patients who fail to respond to 5-ASA. Unlike 5-ASA, corticosteroids do not require direct contact with the inflamed intestinal tissues to be effective.

Oral corticosteroids are potent anti-inflammatory medications. After absorption, corticosteroids exert prompt anti-inflammatory actions throughout the body, including the intestines. Consequently, they are used in treating Crohn’s disease anywhere in the small intestine, as well as ulcerative and Crohn’s colitis. In critically ill patients, intravenous corticosteroids (such as hydrocortisone) can be given in the hospital. For patients with proctitis, hydrocortisone enemas (Cortenema) can be used to deliver the corticosteroid directly to the inflamed tissue. By using the corticosteroid topically, less of it is absorbed into the body and the frequency and severity of side effects are lessened (but not eliminated) as compared with systemic corticosteroids.

Corticosteroids are faster-acting than 5-ASA, and patients frequently experience improvement in their symptoms within days of beginning them. Corticosteroids, however, do not appear to be useful in maintaining remission in Crohn’s disease and ulcerative colitis or in preventing the return of Crohn’s disease after surgery.

Side effects of corticosteroids
The frequency and severity of side effects of corticosteroids depend on the dose and duration of their use. Short courses of corticosteroids usually are well tolerated with few and mild side effects. Examples of side effects of short-course corticosteroids include

rounding of the face (moon face),
acne,
increased body hair,
diabetes,
weight gain,
high blood pressure,
cataracts,
glaucoma,
increased susceptibility to infections,
muscle weakness,
depression,
insomnia,
mood swings,
personality changes,
irritability, and
thinning of the bones (osteoporosis) with fractures of the spine.
Children receiving corticosteroids experience stunted growth.

Long-term use of high doses of corticosteroids usually produces predictable and potentially serious side effects for example, stunted growth in children, aseptic necrosis of the hip joints, and osteoporosis.

Budesonide (Entocort EC)
Budesonide (Entocort EC) is another form of corticosteroid used for treating Crohn’s disease. Like the systemic corticosteroids, budesonide is a potent anti-inflammatory medication. Unlike systemic corticosteroids, budesonide acts only via direct contact with the inflamed tissues (topically) and not systemically.

Budesonide capsules contain granules that allow a slow release of the drug into the ileum and the colon. In a double-blind multicenter study (published in 1998), 182 patients with Crohn’s ileitis and/or Crohn’s disease of the right colon were treated with either budesonide (9 mg daily) or Pentasa (2 grams twice daily). Budesonide was more effective than Pentasa in inducing remissions while the side effects were similar to Pentasa. In another study comparing the effectiveness of budesonide with corticosteroids, budesonide was not better than systemic corticosteroids in treating Crohn’s disease but had fewer side effects.

Because budesonide is broken down by the liver into inactive chemicals, it has fewer side effects than systemic corticosteroids. It also suppresses the adrenal glands less than systemic corticosteroids. Budesonide also is available as an enema for the treatment of proctitis.

Budesonide has not been shown to be effective in maintaining remission in patients with Crohn’s disease. If used long-term, budesonide also may cause some of the same side effects as corticosteroids. Because of this, the use of budesonide should be limited to short-term treatment for inducing remission. As most budesonide is released in the terminal ileum, it will have its best results in Crohn’s disease limited to the terminal ileum.

What antibiotics treat Crohn’s disease and what are their side effects?
Antibiotics such as metronidazole (Flagyl) and ciprofloxacin (Cipro) have been used for treating Crohn’s colitis. Flagyl also has been useful in treating anal fistulae in patients with Crohn’s disease. The mechanism of action of these antibiotics in Crohn’s disease is not well understood.

Metronidazole (Flagyl)
Metronidazole (Flagyl) is an antibiotic that is used for treating several infections caused by parasites (for example, giardia) and bacteria (for example, infections caused by anaerobic bacteria, and vaginal infections). It might have some activity in the treatment of Crohn’s colitis and is particularly useful in treating patients with anal fistulae. Chronic use of metronidazole in doses higher than 1 gram daily can be associated with permanent nerve damage (peripheral neuropathy). The early symptoms of peripheral neuropathy are numbness and tingling in the fingertips, toes, and other parts of the extremities. Metronidazole should be stopped promptly if these symptoms appear. Metronidazole and alcohol together can cause severe nausea, vomiting, cramps, flushing, and headache. Patients taking metronidazole should avoid alcohol. Other side effects of metronidazole include nausea, headaches, loss of appetite, a metallic taste, and, rarely, a rash.

Ciprofloxacin (Cipro)
Ciprofloxacin (Cipro) is another antibiotic used in the treatment of Crohn’s disease. It can be used in combination with metronidazole.

What are immuno-modulator medications and their side effects?
Immuno-modulator drugs decrease tissue inflammation by reducing the population of immune cells and/or by interfering with their production of proteins. Decreasing the activity of the immune system with immuno-modulators increases the risk of infections; however, the benefits of controlling moderate to severe Crohn’s disease usually outweigh the risks of infection due to weakened immunity. Examples of immuno-modulators are:

6-mercaptopurine (6-MP),
azathioprine (Imuran),
methotrexate (Rheumatrex, Trexall, MTX, Mexate),
infliximab (Remicade),
adalimumab (Humira),
certolizumab (Cimzia), and
natalizumab (Tysabri).

How safe is azathioprine and 6-M, what are TPMT genetics?
Azathioprine is converted into 6-MP in the body and 6-MP then is partially converted in the body into inactive and non-marrow toxic chemicals by an enzyme called thiopurine methyltransferase (TPMT). These chemicals then are eliminated from the body. The activity of TPMT enzyme (the ability of the enzyme to convert 6-MP into inactive and non-marrow toxic chemicals) is genetically determined, and approximately 10% of the population in the Untied States has a reduced or absent TPMT activity. In this 10% of patients, 6-MP accumulates and is converted into chemicals that are toxic to the bone marrow where blood cells are produced. Thus, when given normal doses of azathioprine or 6-MP, these patients with reduced or absent TPMT activities can develop seriously low white blood cell counts for prolonged periods of time, exposing them to serious life-threatening infections.

The U.S. Food and Drug Administration recommends doctors check TPMT levels prior to starting treatment with azathioprine or 6-MP. Patients found to have genes associated with reduced or absent TPMT activity are treated with alternative medications or are prescribed substantially lower than normal doses of 6-MP or azathioprine.

Having normal TPMT genes is no guarantee against azathioprine or 6-MP toxicity. Rarely, a patient with normal TPMT genes can develop severe toxicity in the bone marrow and a low white blood cell count even with normal doses of 6-MP or azathioprine. Also, hepatotoxicity in the presence of normal TPMT levels has been reported. All patients taking 6-MP or azathioprine (regardless of TPMT genetics) have to be closely monitored by periodic blood counts and liver enzyme tests for as long as the medication is taken.

Allopurinol (Zyloprim), used in treating high blood uric acids levels, can induce bone marrow toxicity when used together with azathioprine or 6-MP. Allopurinol (Zyloprim) used together with azathioprine or 6-MP has similar effect as having reduced TPMT activity, causing increased accumulation of the 6-MP metabolite that is toxic to the bone marrow.

What are 6-MP metabolite levels?
In addition to monitoring blood cell counts and liver tests, doctors also may measure blood levels of the chemicals that are formed from 6-MP (6-MP metabolites), which can be helpful in several situations such as if a patient’s disease:

is not responding to standard doses of 6-MP or azathioprine and his/her 6-MP blood metabolite levels are low, doctors may increase the 6-MP or azathioprine dose;
is not responding to treatment and his/her 6-MP blood metabolite levels are zero, he/she is not taking his/her medication. The lack of response in this case is due to patient non-compliance.
Patients have been maintained on 6-MP or azathioprine for years without significant long-term side effects. Patients on long-term azathioprine or 6-MP, however, should be closely monitored by their doctors. There are data suggesting that patients on long-term maintenance fare better than those who stop these medications. Thus, those who stop azathioprine or 6-MP are more likely to experience recurrence of their disease and are more likely to need corticosteroids or undergo surgery.

What is azathioprine (Imuran, Azasan) and its side effects?
Azathioprine (Imuran, Azasan) and 6-mercaptopurine (6-MP, Purinethol) are medications that weaken the body’s immune system by reducing the population of a class of immune cells called lymphocytes. Azathioprine and 6-MP are related chemically. In high doses, these two drugs have been useful in preventing rejection of transplanted organs and in treating leukemia. In low doses, they have been used for many years to treat patients with moderate to severe Crohn’s disease and ulcerative colitis.

Azathioprine and 6-MP are increasingly recognized as valuable drugs in treating Crohn’s disease and ulcerative colitis. A majority of patients with moderate to severe disease will benefit from these drugs. Azathioprine and 6-MP are used primarily in the following situations:

Severe Crohn’s disease and ulcerative colitis not responding to corticosteroids.
The presence of undesirable corticosteroid-related side effects.
Corticosteroid dependency, a condition in which patients are unable to discontinue corticosteroids without developing relapses of their disease.
Maintenance of remission.
Side effects of azathioprine and 6-MP include increased vulnerability to infections, inflammation of the liver (hepatitis) and the pancreas (pancreatitis), and bone marrow toxicity (interference with the formation of cells that circulate in the blood).

One problem with 6-MP and azathioprine is their slow onset of action. Typically, full benefit of these drugs is not realized for three months or longer. During this time, corticosteroids frequently have to be maintained at high levels to control inflammation.

Studies have shown that giving higher doses of 6-MP early can hasten the benefit of 6-MP without increasing the toxicity in most patients, but some patients do develop severe bone marrow toxicity. Scientists now believe that an individual’s vulnerability to 6-MP toxicity is genetically inherited. Blood tests can be performed to identify those individuals with increased vulnerability to 6-MP toxicity. Blood tests also can be performed to measure the levels of certain by-products of 6-MP. The levels of these by-products in the blood help doctors to more quickly determine whether the dose of 6-MP is right for the patient.

What is infliximab (Remicade) and its side effects?
Infliximab is approved for the short-term treatment of moderate to severe Crohn’s disease patients who respond inadequately to corticosteroids, azathioprine, or 6-MP.

Infliximab (Remicade) is an antibody that attaches to a protein called tumor necrosis factor-alpha (TNF-alpha). TNF-alpha is one of the proteins produced by immune cells during activation of the immune system. TNF-alpha, in turn, stimulates other cells of the immune system to produce and release other proteins that promote inflammation. In Crohn’s disease, there is continued production of TNF-alpha as part of the immune activation. Infliximab, by attaching to TNF-alpha, blocks its activity and in so doing decreases the inflammation.

Infliximab generally is well tolerated. There have been rare reports of side effects during infusions, including chest pain, shortness of breath, and nausea. These effects usually resolve spontaneously within minutes if the infusion is stopped. Other commonly reported side effects include headache and upper respiratory tract infection.

TNF-alpha is an important protein for defending the body against infections. Infliximab, like immunomodulators, increases the risk for infection. One case of salmonella colitis and several cases of pneumonia have been reported with the use of infliximab. There also have been cases of tuberculosis (TB) reported after the use of infliximab.

More recently, a rare form lymphoma called hepatosplenic T-cell lymphoma has been described associated with azathioprine therapy for Crohn’s disease either alone or in combination with infliximab. Although there is not much known about this disease, it appears to be aggressive and poorly responsive to treatment.

Because infliximab is partly a mouse protein, it may induce an immune reaction when given to humans, especially with repeated infusions. In addition to the side effects that occur while the infusion is being given, patients also may develop a delayed allergic reaction that occurs 7 to 10 days after receiving the infliximab. This type of reaction may cause flu-like symptoms with fever, joint pain and swelling, and a worsening of Crohn’s disease symptoms. It can be serious, and if it occurs, a physician should be contacted. Paradoxically, those patients who have more frequent infusions of infliximab are less likely to develop this type of delayed reaction compared to those patients who receive infusions separated by long intervals (6-12 months).

Rare cases of nerve inflammation such as optic neuritis (inflammation of the nerve of the eye) and motor neuropathy also have been reported with the use of infliximab.
Infliximab can aggravate and cause the spread of an existing infection. It should not be given to patients with pneumonia, urinary tract infections, or abscess (localized collection of pus). It is recommended that patients be tested for TB prior to receiving infliximab. Patients who previously had TB should inform their physician of this before they receive infliximab. Infliximab also can cause the spread of cancer cells and it should not be given to patients with cancer.

Infliximab can promote intestinal scarring (part of the process of healing) and can worsen strictures (narrowed areas of the intestine caused by inflammation and subsequent scaring) and lead to intestinal obstruction. It also can cause partial healing (partial closure) of anal fistulae. Partial closure of fistulae impedes drainage of fluid through the fistulae, and may result in collections of fluid in which bacteria multiply, which can result in abscesses.

The effects of infliximab on the fetus are not known, although the literature suggests this medication is safe for women to continue until week 32 of pregnancy. At that time, the risk of exposure of the fetus to this medication via placental transfer is increased. Infliximab is listed as a pregnancy category B drug by the FDA (meaning that animal studies show no increased risk, but there are no human studies).

Because infliximab is partly a mouse protein, some patients can develop antibodies against infliximab with repeated infusions. Such antibodies can decrease the effectiveness of the drug. The chance of developing such antibodies can be decreased by the concomitant use of 6-MP and corticosteroids.

There are some reports of worsening heart disease in patients who have received infliximab (Remicade). The precise mechanism and role of infliximab in the development of this side effect is unclear. As a precaution, individuals with heart disease should inform their physician of this condition before receiving infliximab.

The long-term safety and effectiveness is not yet known although recent 10 year data from patients who received at least 1 dose of infliximab for CD showed the safety profile similar to what was previously known. In that data set, the treated patients seemed to have an increased risk of developing infections, infusion reactions, autoimmune reactions, and malignancy.

What are adalimumab (Humira), Cimzia, and Tysabri and their side effects?
Humira (adalimumab)
Humira (adalimumab) is used to treat adult patients with moderately to severely active Crohn’s disease. Adalimumab (Humira) is an anti-TNF agent similar to infliximab and decreases inflammation by blocking tumor necrosis factor (TNF-alpha).
Adalimumab generally is well tolerated. The most common side effect is skin reactions at the site of injection with swelling, itching, or redness. Other common side effects include upper respiratory infections, sinusitis, and nausea.
Serious side effects of Humira include infections, tuberculosis, lymphoma, nervous system inflammation, lupus symptoms, worsening heart disease such as heart failure, and rarely, severe allergic reactions with rash, difficulty breathing, and severe low blood pressure or shock.
Certolizumab pegol (Cimzia)
Certolizumab pegol (Cimzia) is used for the treatment of moderate to severe Crohn’s disease in patients who do not respond sufficiently or adequately to standard medical therapy.
Certolizumab is generally well-tolerated. Common side effects of Cimzia include runny or stuffy nose, injection site pain or other injection site reaction, upper respiratory tract infections, urinary tract infections, or a rash.
Serious side effects of Cimzia include possible increase in the risk for serious infections including tuberculosis, worsening of heart failure, and
hypersensitivity reactions, for example, angioedema, hives allergic dermatitis, dizziness, shortness of breath, hot flushes, low blood pressure, malaise, and fainting (syncope). Patients experiencing symptoms of severe allergic reactions should seek emergency care immediately.
Natalizumab (Tysabri)
Natalizumab (Tysabri) is a humanized monoclonal antibody to alpha-4 integrin and is effective in treatment of patients with moderate to severe CD and evidence of inflammation who have not responded to aminosalicylates, antibiotics, corticosteroids, immunomodulators, or TNF inhibitors. Doctors who are registered through the CD TOUCH prescribing program may prescribe this medication to patients. Natalizumab has also been used for some forms of multiple sclerosis.
The most common side effects reported include headache, fatigue, upper respiratory infections, and nausea. The most serious adverse events reported have been hypersensitivity, immunosuppression/infections and progressive multifocal leukoencephalopathy.

What are vedolizumab (Entyvio), ustekinumab (Stelara), and methotrexate (Rheumatrex,Trexall) and their side effects?
Vedolizumab (Entyvio)
Vedolizumab (Entyvio) is a type of monoclonal antibody called an integrin receptor antagonist indicated for adults with moderate to severe ulcerative colitis (UC) or moderate to severe Crohn’s disease (CD) when certain other UC or CD medicines have not worked well enough or cannot be tolerated. Entyvio may help to reduce some symptoms, achieve remission, and reduce or stop the use of corticosteroids. Entyvio works to block the movement of certain gut directed white blood cells into the gastrointestinal (GI) tract, which helps control inflammation and may reduce the symptoms of UC and CD.

The most common side effects of Entyvio include common cold symptoms (runny or stuffy nose, sinus pain, sneezing, cough), headache, joint pain, nausea, fever, infections of the nose and throat, tiredness, fatigue, upper respiratory tract infection, bronchitis, flu symptoms, back pain, rash, itching, sinus infection, sore throat, and pain in your arms or legs.

Serious side effects of Entyvio include infusion reactions, serious allergic reactions, infections, progressive multifocal leukoencephalopathy (PML), and liver problems.

Ustekinumab (Stelara)
Ustekinumab (Stelara) is a human interleukin-12 and -23 antagonist indicated for the treatment of adult patients with moderately to severely active Crohn’s disease (CD) who have failed or were intolerant to treatment with immunomodulators or corticosteroids, but never failed a tumor necrosis factor (TNF) blocker; or failed or were intolerant to treatment with one or more TNF blockers. Stelara is also used to treat plaque psoriasis and psoriatic arthritis.

The most common side effects of Stelara include injection site reactions (bruising, itching, pain, redness, swelling, and hardening of the skin), cold symptoms (stuffy nose, sneezing, sore throat), headache, tired feeling, diarrhea, or skin rash or itching.

Serious side effects of Stelara include serious allergic reactions including feeling faint; swelling of your face, eyelids, tongue, or throat; chest tightness, or skin rash.

Methotrexate (Rheumatrex, Trexall)
Methotrexate (Rheumatrex, Trexall, MTX) is both an immunomodulator and anti-inflammatory medication. Methotrexate has been used for many years in the treatment of severe rheumatoid arthritis and psoriasis. It has been helpful in treating patients with moderate to severe Crohn’s disease who are either not responding to azathioprine and 6-MP or are intolerant of them. Methotrexate also may be effective in patients with moderate to severe ulcerative colitis who are not responding to corticosteroids, azathioprine, or 6-MP.

One major complication of methotrexate is the development of liver cirrhosis when the medication is given over a prolonged period of time (years). The risk of liver damage is higher in patients who also abuse alcohol or are severely obese. Other serious side effects of methotrexate include low white blood cell counts and inflammation of the lungs.

Methotrexate should not be used in pregnant women because of toxic effects on the fetus.

What are 5-ASA (mesalamine) oral medications and their side effects?
5-aminosalicylic acid (5-ASA), also called mesalamine, is similar chemically to aspirin. Aspirin is an anti-inflammatory drug that has been used for many years for treating arthritis, bursitis, and tendonitis (conditions of tissue inflammation). Aspirin is not effective in treating Crohn’s disease and ulcerative colitis and may even worsen the inflammation. Studies suggest that aspirin might actually decrease future risk of developing colorectal cancer in the general population. On the other hand, 5-ASA can be effective in treating Crohn’s disease and ulcerative colitis if the drug can be delivered topically onto the inflamed intestinal lining.

What are biosimilar medications and their side effects?
A biosimilar medication is a drug product that is made to be similar to another already-approved drug. It is tested to be the same as its reference drug in terms of clinical uses, effectiveness, and product safety. A biosimilar medication must meet specific strict standards to be approved by the FDA. A biosimilar is not a generic form of a drug. A generic drug contains the same compounds as the original drug, while a biosimilar drug is highly similar to the reference drug, but not identical. Examples of biosimilars are Infliximab-abda (Renflexis) and Infliximab-dyyb (Inflectra).

Infliximab-abda (Renflexis)
Infliximab-abda (Renflexis) is biosimilar to infliximab (Remicade). Renflexis is a tumor necrosis factor (TNF) blocker used to reduce:

Signs and symptoms of Crohn’s disease and induce and maintain clinical remission in adult patients with moderately to severely active disease who have had an inadequate response to conventional therapy.
The number of draining enterocutaneous and recto-vaginal fistulas and maintain fistula closure in adult patients with fistulizing disease.
The signs and symptoms of Crohn’s disease in children and induce and maintain clinical remission in pediatric patients with moderately to severely active disease who have had an inadequate response to conventional therapy.
Renfexis is also used to treat ulcerative colitis, rheumatoid arthritis (in combination with methotrexate), ankylosing spondylitis, psoriatic arthritis, and plaque psoriasis.

The most common side effects of Renflexis include infections (upper respiratory infection, sinus infection, throat infection, bronchitis, urinary tract infection), infusion-related reactions, headache, abdominal pain, fever or chills, cardiopulmonary reactions (chest pain, high or low blood pressure, shortness of breath), itching, hives, nausea, diarrhea, indigestion, cough, rash, fatigue, yeast infection, and joint pain.

Serious side effects of Renflexis include serious infections, heart failure, liver injury, blood problems, nervous system disorders, allergic reactions, Lupus-like syndrome, and psoriasis.

Infliximab-dyyb (Inflectra)
Infliximab-dyyb (Inflectra) is biosimilar to infliximab (Remicade). Inflectra is a tumor necrosis factor (TNF) blocker used for reducing signs and symptoms of Crohn’s disease and inducing and maintaining clinical remission in adult patients with moderately to severely active disease who have had an inadequate response to conventional therapy.

Inflectra also is used to:

Reduce the number of draining enterocutaneous and recto-vaginal fistulas and maintain fistula closure in adult patients with fistulizing disease.
Reduce the signs and symptoms of pediatric Crohn’s disease and induce and maintain clinical remission in pediatric patients with moderately to severely active disease who have had an inadequate response to conventional therapy.
Treat ulcerative colitis, rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, and plaque psoriasis.
The most common side effects of Inflectra include respiratory infections, bronchitis, sinus infections and sore throat, runny or stuffy nose, headache, coughing, stomach/abdominal pain, nausea, diarrhea, indigestion, fatigue, pain, oral thrush, joint pain, and urinary tract infection (UTI). Infusion reactions can happen up to two hours after an infusion. Symptoms of infusion reactions may include fever, chills, chest pain, low blood pressure (hypotension) or high blood pressure (hypertension), shortness of breath, rash and itching.

Serious side effects of Inflectra include serious infections, heart failure, liver injury, blood problems, nervous system disorders, allergic reactions, Lupus-like syndrome, and psoriasis.

When is surgery necessary to treat Crohn’s disease?
There is no surgical cure for Crohn’s disease. Even when all of the diseased parts of the intestines are removed, inflammation frequently recurs in previously healthy intestines months to years after the surgery. Surgery in Crohn’s disease is used primarily for:

Removal of a diseased segment of the small intestine that is causing obstruction.
Drainage of pus from abdominal and perirectal abscesses.
Treatment of severe anal fistulae that do not respond to drugs.
Resection of internal fistulae (such as a fistula between the colon and bladder) that are causing infections.
Usually, after the diseased portions of the intestines are removed surgically, patients can be free of disease and symptoms for some time, often years. When successfully performed, surgery can lead to a marked improvement in a patient’s quality of life. In many patients, Crohn’s disease eventually returns, affecting previously healthy intestines. The recurrent disease usually is located at or near the site of surgery. In fact, half of patients can expect to have a recurrence of symptoms within four years of surgery. Drugs such as Pentasa or 6-MP have been useful in some patients to reduce the chances of relapse of Crohn’s disease after surgery.

There is accumulating evidence in favor of post-operative therapy to delay recurrence in Crohn’s disease. There appears to be some benefit of mesalamine in reducing the risk of post-op recurrence for up to 3 years. A study has shown infliximab to be effective in preventing postoperative recurrence after ileocecal resection, though relapse may occur when therapy is stopped.

Treatment strategies by severity and location of disease (Based on the Second European Evidence-Based Consensus on the Diagnosis and Management of Crohn’s Disease.)

Mild to Moderate Active Disease
Commonly treated with oral mesalamine 3.2-4 g daily or sulfasalazine for ileocolonic or colonic disease as 3-6 g daily in divided doses (this approach has more recently been reported to be not very effective).
Budesonide (9 mg/day) is effective for disease confined to ileum and/or right colon.
Proton pump inhibitors might help with symptomatic improvement in patients with upper gastrointestinal Crohn’s disease.
Moderate to Severe Disease
Prednisone 40-60 mg/day until resolution of symptoms.
Appropriate antibiotic therapy for infection or abscess.
Azathioprine and 6-MP are effective for maintaining a steroid-induced remission.
Methotrexate 25 mg/wk is effective for steroid-dependent and steroid-refractory Crohn’s disease.
Infliximab, adalimumab, and certolizumab pegol are effective in the treatment of moderate to severely active disease in patients who have not responded to adequate therapy with a steroid or immunosuppressive agent.
Natalizumab is effective in the treatment of patients with moderate to severely active CD who have had an inadequate response or are unable to tolerate conventional Crohn’s disease therapy and anti-TNF antibody therapy.
Perianal or Fistulizing Disease
Surgical drainage for abscess
Otherwise, treated medically with antibiotics (metronidazole), immunosuppressives, or infliximab.

What are the complications of Crohn’s disease, is it fatal??
Complications of Crohn’s disease may be related or unrelated to the inflammation within the intestine.

Intestinal complications of Crohn’s disease include:

obstruction and perforation of the small intestine,
abscesses (collections of pus),,
fistulae, and
intestinal bleeding.
Massive distention or dilatation of the colon (megacolon), and rupture (perforation) of the intestine are potentially fatal complications. Both generally require surgery, but, fortunately, these two complications are rare. Recent data suggest that there is an increased risk of cancer of the small intestine and colon in patients with long-standing Crohn’s disease.

Extra-intestinal complications involve the skin, joints, spine, eyes, liver, and the bile ducts.

Skin involvement includes painful red raised spots on the legs (erythema nodosum) and an ulcerating skin condition generally found around the ankles called pyoderma gangrenosum.

Painful eye conditions (uveitis, episcleritis) can cause visual difficulties.

Arthritis can cause pain, swelling, and stiffness of the joints of the extremities.

Inflammation of the low back (sacroiliac joint arthritis) and of the spine (ankylosing spondylitis) can cause pain and stiffness of the spine.

Inflammation of the liver (hepatitis) or bile ducts (primary sclerosing cholangitis) also can occur. Sclerosing cholangitis causes narrowing and obstruction of the bile ducts draining the liver and can lead to yellow skin (jaundice), recurrent bacterial infections, and liver cirrhosis with liver failure. Sclerosing cholangitis with liver failure is one of the reasons for performing liver transplantation. It also is frequently complicated by the development of cancer of the bile ducts. Patients with Crohn’s disease might also suffer from an increased tendency to form blood clots (hypercoagulability).

Can Crohn’s disease be cured, what is the prognosis?
There is no cure for Crohn’s disease, only treatments for pain and other syptoms.
Crohn’s disease is a chronic inflammatory disease involving predominantly the small intestine and colon. The symptoms and the activity of the disease can come and go. Even though many effective medications are available to control the activity of the disease, there is as yet no cure for Crohn’s disease.
Surgery can significantly improve the quality of life in selected individuals, but recurrence of the disease after surgery is common.
Crohn’s disease can have complications, both within and outside of the intestine.
Newer treatments are actively being evaluated.
A better understanding of the role of genetics and environmental factors in the cause of Crohn’s disease may lead to improved treatments and prevention of the disease.
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Abdominal Pain Pictures
Abdominal pain is a symptom of many possible conditions including appendicitis, ulcers, irritable bowel syndrome, indigestion, and other conditions. It may accompany constipation, diarrhea, vomiting, and other symptoms. Find out the potential causes of pain in the abdomen and learn when you should see a doctor.

Anal Fissure
An anal fissure is a small tear or cut in the skin lining of the anus. Pain and/or rectal bleeding during bowel movements are common symptoms of anal fissures. Treatment includes increasing liquid intake, using stool softeners, prescription medications, and surgery.

Ankylosing Spondylitis
Ankylosing spondylitis is a type of arthritis that causes chronic inflammation of the spine. The tendency to develop ankylosing spondylitis is genetically inherited. Treatment incorporates medications, physical therapy, and exercise.

Barium Enema
The barium enema and double contrast barium enema are used to define normal and abnormal anatomy of the colon and rectum. A lower GI series, also known as a barium enema, barium enema procedure, barium enema X-ray, or double-contrast barium enema, is an X-ray test in which a white liquid, called barium, is infused through a catheter (tube) inserted through the anus and into the rectum until it fills the large bowel (colon).

Cancer Risk Factors
Though it’s difficult to say why some people develop cancer while others don’t, research shows that certain risk factors increase a person’s odds of developing cancer. These risk factors include growing older, family history of cancer, diet, alcohol and tobacco use, and exposure to sunlight, ionizing radiation, certain chemicals, and some viruses and bacteria.

Canker Sores
Canker sores are a common complaint, and are small ulcers on the inside of the mouth. Canker sores aren’t contagious (as opposed to cold sores), and typically last for 10-14 days usually healing without scarring. A variety of things cause canker sores, for example, medications (aspirin, beta-blockers, NSAIDs, high blood pressure medication, and antibiotics); injury to the mouth from dental work, braces, or sports accidents; acidic foods; allergies; and diseases or conditions like celiac disease, Crohn’s disease, and lupus. Canker sores can be cure with home remedies, and prescription and OTC topical and oral medication.

CT Scan (Computerized Tomography)
A CT scan is an X-ray procedure that combines many X-ray images with the aid of a computer to generate cross-sectional and three-dimensional images of internal organs and structures of the body. A CT scan is a low-risk procedure. Contrast material may be injected into a vein or the spinal fluid to enhance the scan.

Clostridium Difficile Colitis (C. diff, C. difficle Colitis)
Clostridium difficile (C. difficile) is a bacterium, and is one of the most common causes of infection of the colon. C. difficile spores are found frequently in hospitals, nursing homes, extended care facilities, and nurseries for newborn infants.

Colonoscopy Procedure
A colonoscopy is a procedure whereby a docotor inserts a viewing tube (colonoscope) into the rectum for the purpose of inspecting the colon. Colonoscopy is the best method currently available to diagnose, detect, and treat abnormalities within the colon.

Colostomy: A Patient’s Perspective
Colostomy surgery is commonly performed by severing the colon to attach the end leading to the stomach to the skin through the wall of the abdomen. There are several types of colostomy procedures, however the “Hartmann’s Colostomy” is the most common. Colostomy care of the colostomy bag(s) is important to recovering from colostomy surgery.

Crohn’s Disease Quiz
What causes Crohn’s disease? What are the symptoms of Crohn’s disease? How is Crohn’s treated? Take this quiz to get the facts about Crohn’s.

Crohn’s Disease: Symptoms, Causes, Diet
What is Crohn’s disease? Get more information on this digestive disorder and how Crohn’s can affect your diet. Learn more about tests to diagnose Crohn’s disease, as well as treatments for Crohn’s.

Endoscopy (EGD) Procedure
Endoscopy is a broad term used to described examining the inside of the body using an lighted, flexible instrument called an endoscope. Endoscopy procedure is performed on a patient to examine the esophagus, stomach, and duodenum; and look for causes of symptoms such as abdominal pain, nausea, vomiting, difficulty swallowing, or intestinal bleeding.

IBD Slideshow
What is inflammatory bowel disease? IBD can include Crohn’s disease and ulcerative colitis. Learn more about testing, treatments, and the home care needed to manage inflammatory bowel disease.

Stomach Picture
The stomach is a muscular sac located on the left side of the upper abdomen. See a picture of the Stomach and learn more about the health topic.

Tummy Trouble Quiz
Tummy Troubles? Get a better idea of what’s causing the nausea, vomiting, bloating, gas, constipation, diarrhea, pain, and other gastrointestinal discomforts and problems. Take the Tummy Troubles Quiz!

Ulcerative Colitis
Ulcerative Colitis is a form of inflammatory bowel disease and is slightly different than Crohn’s disease. Learn the causes, symptoms, diet, and treatment options associated with ulcerative colitis.
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adalimumab (Humira)
Rheumatoid Arthritis Slideshow Pictures
Take the RA Quiz
Joint-Friendly Exercises to Reduce RA Pain Slideshow
What is adalimumab, and how does it work (mechanism of action)?
What are the side effects of adalimumab?
What is the dosage for adalimumab?
Is adalimumab safe to take if I’m pregnant or breastfeeding?
What else should I know about adalimumab?

What is adalimumab, and how does it work (mechanism of action)?
Rheumatoid arthritis
Humira is indicated for reducing signs and symptoms, inducing major clinical response, inhibiting the progression of structural damage, and improving physical function in adult patients with moderately to severely active rheumatoid arthritis. HUMIRA can be used alone or in combination with methotrexate or other disease-modifying anti-rheumatic drugs (DMARDs).

Psoriatic arthritis
Humira is indicated for reducing signs and symptoms of active arthritis, inhibiting the progression

of structural damage, and improving physical function in patients with psoriatic arthritis. Humira can be
used alone or in combination with DMARDs.

Ankylosing spondylitis
Humira is indicated for reducing signs and symptoms in patients with active ankylosing spondylitis.

Crohn’s disease
Humira is indicated for reducing signs and symptoms and inducing and maintaining clinical

remission in adult patients with moderately to severely active Crohn’s disease who have had an inadequate
response to conventional therapy. Humira is indicated for reducing signs and symptoms and inducing
clinical remission in these patients if they have also lost response to or are intolerant to infliximab.

Plaque psoriasis
Humira is indicated for the treatment of adult patients with moderate to severe chronic plaque psoriasis who are candidates for systemic therapy or phototherapy, and when other systemic therapies are medically less appropriate. Humira should only be administered to patients who will be closely monitored and have regular follow-up visits with a physician.

How does humira work?
Adalimumab is an injectable protein(antibody) that blocks the inflammatory effects of tumor necrosis factor alpha (TNF alpha) in rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, and Crohn ‘s disease of the intestine.

Inflammation is the body’s reaction to injury and is a necessary process for the repair of injury. TNF is a protein that the body produces when there is inflammation. TNF promotes inflammation and the signs of inflammation, which, in the case of arthritis, include fever as well as pain, tenderness, and swelling of joints.

In the case of Crohn’s disease, the signs of inflammation include fever, abdominal pain, and diarrhea. The unchecked inflammation of rheumatoid arthritis eventually leads to destruction of the joints. The inflammation in Crohn’s disease can lead to strictures (narrowing) of the intestine or intestinal perforation.

Adalimumab is a synthetic (man-made) antibody that binds to TNF in the body and thereby blocks the effects of TNF. As a result, inflammation and its consequences in the joints and intestine are reduced. In arthritis, the progressive destruction of the joints is slowed or prevented. Adalimumab is a disease modifying anti-rheumatic drugs (DMARD) because it slows or prevents destruction of joints.

Adalimumab was approved by the FDA in December 2002.

What brand names are available for adalimumab?
Humira

Is adalimumab available as a generic drug?
No

Do I need a prescription for adalimumab?
Yes

What are the side effects of adalimumab?
WARNING
Like other drugs that block TNF, use of adalimumab also has been associated with serious infections such as tuberculosis, sepsis (bacteria in the blood) and fungal infections.

Individuals with active infections should not be treated with adalimumab. Adalimumab also may worsen the symptoms of diseases of the nervous system. In studies some patients who used adalimumab or other TNF blocking drugs developed cancer. Since patients with rheumatoid arthritis have a higher rate of cancers than the general population, the connection between cancer and use of adalimumab is unclear.

Common side effects
The most common side effects are:

headache,
rash,
nausea and
stomach upset.
Adalimumab may cause swelling, redness, pain and itching at the site of injection. Adalimumab suppresses the immune system and is therefore associated with minor infections of the urinary tract, respiratory tract, and sinuses.

Other side effects of adalimumab include:

hypersensitivity reactions (including anaphylaxis) and
reduced levels in the blood of platelets and red cells (aplastic anemia).
Adalimumab may increase the risk of reactivating hepatitis B virus in chronic carriers of the virus.

SLIDESHOW
What Is Rheumatoid Arthritis (RA)? Symptoms, Treatment, Diagnosis
See Slideshow

What is the dosage for adalimumab?
Humira is administered by subcutaneous injection.

Rheumatoid Arthritis, Psoriatic Arthritis, Ankylosing Spondylitis
40 mg every other week. Some patients with RA not receiving methotrexate may benefit from increasing the frequency to 40 mg every week.

Crohn’s Disease
Initial dose (Day 1) is 160 mg (four 40 mg injections in one day or two 40 mg injections per day for two consecutive days), followed by 80 mg two weeks later (Day 15). Two weeks later (Day 29) begin a maintenance dose of 40 mg every other week.

Plaque Psoriasis
80 mg initial dose, followed by 40 mg every other week starting one week after initial dose.

Is adalimumab safe to take if I’m pregnant or breastfeeding?
Adalimumab has not been adequately studied in pregnant women.

Use of adalimumab by nursing mothers has not been adequately evaluated.

What else should I know about adalimumab?
What preparations of adalimumab are available?
Prefilled glass syringe: 20 mg/0.4 ml and 40 mg/0.8 ml; Prefilled pen: 40 mg/0.8 ml.

How should I keep adalimumab stored?
Adalimumab should be refrigerated at 2-8 C (36-46 F).

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Summary
Adalimumab (Humira) is a drug prescribed for reducing the symptoms and signs of rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, plaque psoriasis, juvenile idiopathic arthritis, and Crohn’s disease. Side effects, drug interactions, and pregnancy safety information should be reviewed prior to taking this medication.

Multimedia: Slideshows, Images & Quizzes
Psoriasis Quiz: Test Your Medical IQ
Psoriasis Quiz: Test Your Medical IQ
Take the mystery out of psoriasis. Take the Psoriasis Quiz and see what you know about the types, symptoms, treatments and more.

Ankylosing Spondylitis Quiz: Symptoms & Treatment
Ankylosing Spondylitis Quiz: Symptoms & Treatment
What is ankylosing spondylitis? Take this quiz to learn the causes, symptoms, and treatments for this painful disorder.

Rheumatoid Arthritis Quiz: What is Rheumatoid Arthritis?
Rheumatoid Arthritis Quiz: What is Rheumatoid Arthritis?
How is rheumatoid arthritis different from other forms of arthritis, such as osteoarthritis and gout? Take the Rheumatoid…

What Is Rheumatoid Arthritis (RA)? Symptoms, Treatment, Diagnosis
What Is Rheumatoid Arthritis (RA)? Symptoms, Treatment, Diagnosis
What is rheumatoid arthritis (RA)? Learn about treatment, diagnosis, and the symptoms of juvenile rheumatoid arthritis. Discover…

Types of Psoriasis: Medical Pictures and Treatments
Types of Psoriasis: Medical Pictures and Treatments
Learn about the common skin condition psoriasis. Explore about the different types of psoriasis such as vulgaris (plaque…

Ankylosing Spondylitis: Symptoms, Diagnosis, and Treatment
Ankylosing Spondylitis: Symptoms, Diagnosis, and Treatment
What is ankylosing spondylitis (AS)? Ankylosing spondylitis is arthritis of the spine. Learn diet and exercise tips for AS, and…

Related Disease Conditions
Ankylosing Spondylitis
Ankylosing Spondylitis
Ankylosing spondylitis is a type of arthritis that causes chronic inflammation of the spine. The tendency to develop ankylosing spondylitis is genetically inherited. Treatment incorporates medications, physical therapy, and exercise.

Juvenile Rheumatoid Arthritis (JRA)
Juvenile Rheumatoid Arthritis (JRA)
Juvenile rheumatoid arthritis (JRA) annually affects one child in every thousand. There are six types of JRA. Treatment of juvenile arthritis depends upon the type the child has and should focus on treating the symptoms that manifest.

Crohn’s Disease
Crohn’s Disease
Crohn’s disease is a chronic inflammatory disease, primarily involving the small and large intestine, but which can affect other parts of the digestive system as well. Abdominal pain, diarrhea, vomiting, fever, and weight loss are common symptoms.

Psoriasis
Psoriasis
Psoriasis is a long-term skin condition that may cause large plaques of red, raised skin, flakes of dry skin, and skin scales. There are several types of psoriasis, including psoriasis vulgaris, guttate psoriasis, inverse psoriasis, and pustular psoriasis. Symptoms vary depending on the type of psoriasis the patient has. Treatment of psoriasis may include creams, lotions, oral medications, injections and infusions of biologics, and light therapy. There is no cure for psoriasis.

Psoriatic Arthritis
Psoriatic Arthritis
Psoriatic arthritis is a disease that causes skin and joint inflammation. Symptoms and signs include painful, stiff, and swollen joints, tendinitis, and organ inflammation. Treatment involves anti-inflammatory medications and exercise.

Rheumatoid Arthritis (RA)
Rheumatoid Arthritis (RA)
Rheumatoid arthritis (RA) is an autoimmune disease that causes chronic inflammation of the joints, the tissue around the joints, as well as other organs in the body. Because it can affect multiple other organs of the body, rheumatoid arthritis is referred to as a systemic illness and is sometimes called rheumatoid disease. The 16 characteristic early RA signs and symptoms include the following. Anemia Both sides of the body affected (symmetric) Depression Fatigue Fever Joint deformity Joint pain Joint redness Joint stiffness Joint swelling Joint tenderness Joint warmth Limping Loss of joint function Loss of joint range of motion Many joints affected (polyarthritis)

Sarcoidosis
Sarcoidosis
Sarcoidosis, a disease resulting from chronic inflammation, causes small lumps (granulomas) to develop in a great range of body tissues and can appear in almost any body organ. However, sarcoidosis most often starts in the lungs or lymph nodes.

Arthritis (Joint Inflammation)
Arthritis (Joint Inflammation)
Arthritis is inflammation of one or more joints. When joints are inflamed they can develop stiffness, warmth, swelling, redness and pain. There are over 100 types of arthritis, including osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, lupus, gout, and pseudogout.

Relapsing Polychondritis
Relapsing Polychondritis
Relapsing polychondritis is an uncommon, chronic disorder of the cartilage that is characterized by recurrent episodes of inflammation of the cartilage of various tissues of the body. Tissues containing cartilage that can become inflamed include the ears, nose, joints, spine, and windpipe (trachea). Tissues that have a biochemical makeup similar to that of cartilage such as the eyes, heart, and blood vessels, can also be affected. Nonsteroidal anti-inflammatory medications (NSAIDs) is used as treatment for mild cases of the disease. Steroid-related medications also are usually required.

Scleritis
Scleritis
Scleritis is inflammation of the white part of the eye. It may be caused by a serious underlying condition, such as an autoimmune disease. Symptoms include redness, pain, tearing, sensitivity to light, and decreased visual acuity. Treatment may include eyedrops as well as treatment for any underlying disease process. Scleritis cannot be prevented.

Scalp Psoriasis (Psoriasis of the Scalp)
Scalp Psoriasis (Psoriasis of the Scalp)
Scalp psoriasis causes red, raised, scaly patches that may extend from the scalp to the forehead and the back of the neck and ears. Symptoms and signs include itching, hair loss, flaking, silvery scales, and red plaques. Treatment includes topical medicated shampoos, creams, gels, oils, ointments, and soaps, medications, and light therapy.

Hidradenitis Suppurativa (Acne Inversa)
Hidradenitis Suppurativa (Acne Inversa)
Hidradenitis suppurativa (HS or acne inversa) is a chronic skin condition that causes painful red abscesses in the groin and armpits that may drain foul-smelling pus. Treatment options include weight loss, smoking cessation, topical antibiotics, and avoidance of tight-fitting underwear. Finasteride and adalimumab may be helpful for those with resistant cases of HS.

Osteoarthritis vs. Rheumatoid Arthritis
Osteoarthritis vs. Rheumatoid Arthritis
Osteoarthritis (OA) and rheumatoid arthritis (RA) are chronic joint disorders. RA is also an autoimmune disease. OA and RA symptoms and signs include joint pain, warmth, and tenderness. Over-the-counter pain relievers treat both diseases. There are several prescription medications that treat RA.

Rheumatoid Arthritis vs. Arthritis
Rheumatoid Arthritis vs. Arthritis
Arthritis is a general term used to describe joint disease. Rheumatoid arthritis (RA) is a type of arthritis in which the body’s immune system mistakenly attacks the joints, causing chronic inflammation.

Treatment & Diagnosis
Procedures & Tests Symptoms & Signs FAQs & Doctor’s Views
Tuberculosis Skin Test (PPD Skin Test)
Doctor: Checklist to Take To Your Doctor’s Appointment
Rheumatoid Arthritis (RA)
Psoriasis
Psoriatic Arthritis
Crohn’s Disease
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Inflammatory Bowel Disease
Hidradenitis Suppurativa (Acne Inversa)
Behcet’s Syndrome
Non-Radiographic Axial Spondyloarthritis (nr-axSpA)
Mixed Connective Tissue Disease (MCTD)
Uveitis
Rheumatoid Arthritis FAQs
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Prescriptions: Complying with the Doctor’s Orders
How To Reduce Your Medication Costs
Pharmacy Visit, How To Get The Most Out of Your Visit
Indications for Drugs: Approved vs. Non-approved
National Arthritis Meeting 2003
Rheumatoid Arthritis Perspectives:2003 National Meeting
Arthritis Drugs and New Meds: 2004 Perspectives
Drugs: The Most Common Medication Errors
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Drugs: Buying Prescription Drugs Online Safely
Generic Drugs, Are They as Good as Brand-Names?
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Medications FDA Drug Labels on RxList.com
etanercept (Enbrel)
infliximab (Remicade)
Drug Interactions
dalteparin injection (Fragmin)
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Humira (adalimumab) Side Effects, Warnings, and Drug Interactions
Neoral
Duexis
Zostavax
Xeljanz
Humira
Cimzia
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Prevention & Wellness
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The 10 Most-Prescribed and Top-Selling Medications
Some Arthritis Meds Cost Seniors Thousands Annually
Biosimilar Drugs: FAQ
Many Rheumatoid Arthritis Patients May Skip Meds: Study
Popular Crohn’s, Colitis Drugs Not Linked to Short-Term Cancer Risk: Study
Drug Shows Promise Against Arthritis Common in People with Psoriasis
Some Types of Skin Cancer Linked to Lower Chances of Alzheimer’s
Newer Rheumatoid Arthritis Drugs Don’t Seem to Increase Risk of Shingles
Lupus May Be Linked to Serious Pregnancy Complication
Humira Approved for Ulcerative Colitis Treatment
Newer Rheumatoid Arthritis Drugs Don’t Raise Cancer Risk: Study
Some Psoriasis Therapies May Cut Heart Attack Risk
Humira Might Help Kids With Tough-to-Treat Crohn’s Disease
Study Compares Safety of ‘Biologic’ Meds for Rheumatoid Arthritis
Newer Drugs Help RA Patients Live Longer
Study: Actemra Tops Rival in Rheumatoid Arthritis
Psoriasis Guidelines Call for Tailored Treatment
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Drug Name Confusion: Preventing Medication Errors

QUESTION
The term arthritis refers to stiffness in the joints.
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