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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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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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Lower respiratory tract disorders present challenges that often require skilled and nuanced approaches for effective management. Common ailments, such as asthma and chronic obstructive pulmonary disease (COPD), have prompted the development of intricate treatment strategies involving bronchodilators and anti-inflammatory drugs, each tailored to ease breathing and revitalize the lungs.
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Glucocorticoids, a class of anti-inflammatory drugs, are pivotal in treating moderate to severe Crohn's disease by inducing remission. They exhibit their anti-inflammatory action by inhibiting the production of inflammatory cytokines such as tumor necrosis factor (TNF)-α, interleukin (IL)-1, and chemokines like IL-8. In addition, they reduce the expression of inflammatory cell adhesion molecules and inhibit gene transcription of nitric oxide synthase, phospholipase A2, cyclooxygenase-2...
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Newer Immunosuppressants for Rheumatologic Disease: Preoperative Considerations.

Ye Rin Koh1, Kenneth C Cummings1

  • 1Anesthesiology Institute, Cleveland Clinic, 9500 Euclid Avenue, E-31, Cleveland, OH 44195, USA.

Rheumatic Diseases Clinics of North America
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Summary

Patients with rheumatic diseases have many immune-modulating treatments, including small-molecule immune modulators, fusion proteins, and monoclonal antibodies. This review covers these immunosuppressants and offers guidance on managing them around surgery.

Keywords:
Biologic therapyMedication therapy managementPerioperative periodRheumatic diseases

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Area of Science:

  • Rheumatology
  • Immunology
  • Pharmacology

Background:

  • Rheumatic diseases encompass a range of autoimmune and inflammatory conditions.
  • Treatment options have expanded significantly with novel immunomodulatory agents.
  • These advanced therapies offer improved efficacy but carry substantial risks.

Purpose of the Study:

  • To review current immunosuppressant treatments for rheumatic diseases.
  • To discuss the implications of these treatments during the perioperative period.
  • To provide evidence-based recommendations for perioperative management.

Main Methods:

  • Comprehensive literature search of immunosuppressant therapies.
  • Analysis of perioperative risks and benefits associated with immunomodulators.
  • Synthesis of current guidelines and expert opinion on perioperative care.

Main Results:

  • Broad spectrum of immunosuppressants available, including small-molecule immune modulators, fusion proteins, and monoclonal antibodies.
  • Significant risks associated with these agents necessitate careful patient selection and monitoring.
  • Individualized risk-benefit assessment is crucial for optimal patient outcomes.

Conclusions:

  • Management of immunosuppressants in rheumatic disease patients requires a personalized approach.
  • Perioperative management strategies are essential to mitigate risks and ensure treatment continuity.
  • Further research is needed to refine perioperative guidelines for novel immunomodulatory agents.