How to treat mild CD?

I found this article on JAMA regarding the current management of Crohn's Disease.  It states that Mesalamine should no longer be used due to the lack of evidence.  Here's an excerpt:

"The conventional approach for Crohn disease treatment is administration of mesalamines and multiple courses of corticosteroids prior to escalation to immunosuppressive therapy. This is what Mr C received. However, this approach does not decrease complication or surgery rates."

Link: http://jama.jamanetwork.com/article.aspx?articleid=1690713

What is first line therapy for Crohn's for someone like me who is asymptomatic?  I am not officially diagnosed yet, but i'm sure its only a matter of time.  I have a doctors appointment in a week. Will probably do more tests but he thinks its CD.  I am prescribed Lialda, but if its Crohns there's no reason for me to be taking Lialda because literature does not support it.

My background: 3 more months till a receive my PharmD.

Post Edited (cocopuffs809) : 2/3/2014 1:39:31 PM (GMT-7)

Mild disease can become severe disease, but it might just stay mild, regardless of treatment.

I know this is from a rival forum - please forgive me, oh merciful HW - but this is a very interesting thread discussing the use of 5-ASA in treating mild Crohn's. Do read the whole thing.

www.crohnsforum.com/showthread.php?t=36292

I will add one caveat: mild disease can turn into severe disease and become infinitely harder to treat, as I found out the hard way. Monitor the **** out of your disease and get onto stronger drugs if it shows any sign of progressing. Best of luck.

Thanks for the link NCOT, it was a very educational read.

Another question for you all, I do intend to monitor the **** out of this disease. How do I do that? Do I monitor labs? Perform colonoscopies yearly? Thank you. What if someone mild like me were to be started on remicade or another biologic? I wonder if more mild people would achieve "deep remission." I am just thinking out loud. I am still reading literature and haven't read much about remicade and crohns yet.

cocopuffs809 said...
Thanks for the link NCOT, it was a very educational read.

Another question for you all, I do intend to monitor the **** out of this disease. How do I do that? Do I monitor labs? Perform colonoscopies yearly? Thank you. What if someone mild like me were to be started on remicade or another biologic? I wonder if more mild people would achieve "deep remission." I am just thinking out loud. I am still reading literature and haven't read much about remicade and crohns yet.

You're welcome.

Oddly enough, I'm sort of in a similar boat to you right now. Surgery put me into remission almost one year ago, but as we all know, as surely as the Prodigal Son, Crohn's will return. My GI wanted me to go on azathioprine after surgery (he didn't even bother mentioning going on a 5-ASA), but as long as my inflammatory markers were normal, I didn't really want to go back on an immunesuppressant.

Lab markers are a very good start, although unfortunately not infallible. (Not everybody's CRP rises during a flare-up, for example, but if yours does, then CRP is a good rough guide to disease activity. The same goes for a few other markers, like faecal calprotectin, platelets, ESR, ferritin, haemoglobin, etc.) Bit of a lengthy read, but this article is a very good guide to the use of inflammatory markers in IBD:
www.ncbi.nlm.nih.gov/pmc/articles/PMC1856093/

Anyway, back in November my CRP was 7 (used to be considerably higher than that). I'm seeing my GP tomorrow and will ask him for a full blood count: if my CRP has risen, haemoglobin dropped, etc., then I'll get in touch with the hospital and ask for further testing.

Try to get the faecal calprotectin test if you can. PPIs and NSAIDs can give false positives, but other than that it's a very sensitive test for intestinal inflammation. Speaking of which, I still haven't got my FC result from last November. Hmm...

I wouldn't say yearly colonoscopies were required as a matter of course; generally speaking, it's better to reserve colonoscopies for when there's a significant change of symptoms. Keeping a close eye on symptoms and laboratory markers is probably the best way to monitor stable disease. You say you are asymptomatic, but in your last thread you said you had bloody stools for 4 months: that's absolutely a symptom! Think more carefully about whether there are more subtle or occasional symptoms you might be missing: loose stools, cramping, gas, urgency, low-grade fevers, etc. Note them all down.

I had basically mild disease for the first 5 years. I did not keep a diary, and so I did not notice that things were very slowly getting worse. Certain things are likely to make more sense in retrospect. It may also be a good idea to keep a food diary: some people respond really well to dietary changes, but for others it doesn't make the blindest bit of difference. However, dietary changes can be a useful form of symptom control (rarely enough to control Crohn's disease solely, imo, although there will be some who will disagree with this).

gumby44 said...
Welcome to the forum and hang out with us...we can use your brain!!

Yeah, with your PharmD, you can start to teach us >_>

*collapses*