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Upon diagnosis, managing Inflammatory Bowel Disease (IBD) involves addressing several crucial aspects. The primary goals include resting the bowel, correcting malnutrition, and providing symptomatic relief. Resting the bowel may consist of medications to reduce inflammation and promote healing. Correcting malnutrition is essential, often requiring dietary adjustments and nutritional supplements. Symptomatic relief aims to ease pain, diarrhea, and other discomforts in IBD.
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Various diagnostic tests are employed in the diagnostic process for Inflammatory Bowel Disease (IBD), particularly to differentiate between Crohn's disease and ulcerative colitis.
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Tumor Necrosis Factor (TNF), a proinflammatory cytokine, contributes significantly to the inflammation seen in Crohn's disease. It exists as soluble TNF and membrane-bound TNF, with actions mediated through TNF receptors (TNFR). TNFR activation leads to the release of proinflammatory cytokines, T-cell activation, collagen production, and leukocyte migration, all contributing to inflammation in Crohn's disease. Anti-TNF monoclonal antibodies, namely infliximab (Remicade), adalimumab...
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Crohn's disease is an inflammatory bowel disorder marked by chronic inflammation of the GI tract. Various treatment strategies for Crohn's disease are employed, such as immunomodulatory agents, glucocorticoids, and biologics or anti-TNF therapy. Azathioprine (Imuran), a commonly used immunomodulatory drug for Crohn's disease, is converted in the body to mercaptopurine, which inhibits purine biosynthesis and cell proliferation. Both are utilized in severe cases of Inflammatory Bowel...
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Development of an algorithm for IgG4-related disease management.

Olimpia Orozco-Gálvez1, Andreu Fernández-Codina2, Marco Lanzillotta3

  • 1Division of Systemic Autoimmune Diseases, Internal Medicine Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.

Autoimmunity Reviews
|January 22, 2023
PubMed
Summary

Management of IgG4-related disease (IgG4-RD) is now guided by European expert consensus. Glucocorticoids are first-line, with rituximab an option, and treatment tailored to individual patient needs.

Keywords:
AlgorithmIgG4-related diseaseImmunoglobulinTreatment

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Area of Science:

  • Rheumatology
  • Immunology
  • Internal Medicine

Background:

  • IgG4-related disease (IgG4-RD) is a rare, multi-organ fibro-inflammatory condition.
  • Standardized management protocols for IgG4-RD are lacking.

Purpose of the Study:

  • To develop European expert-based statements for IgG4-RD management.
  • To integrate these statements into a clinical management algorithm.

Main Methods:

  • A Delphi exercise involving nine European IgG4-RD experts.
  • Three rounds of surveys to reach consensus (≥75% agreement).

Main Results:

  • Thirty-one consensus statements were established covering induction, maintenance, and non-pharmacological treatments.
  • Glucocorticoids (GC) are first-line; rituximab is effective but cost-dependent.
  • Maintenance therapy is recommended for high disease activity or relapse risk; imaging, including FDG-PET/CT, aids follow-up.

Conclusions:

  • The developed statements and algorithm achieved high agreement.
  • These guidelines aim to assist in the clinical management of IgG4-related disease.