From the Guidelines
Managing chronic inflammatory diseases requires a comprehensive approach that prioritizes the latest and highest quality evidence, which currently suggests a combination of medication, lifestyle changes, and regular medical monitoring, with a focus on biologic therapies such as TNF inhibitors for moderate to severe cases, as supported by the most recent study 1.
Key Components of Management
- Medication: Treatment typically begins with anti-inflammatory medications such as NSAIDs (ibuprofen 400-800mg three times daily or naproxen 500mg twice daily), corticosteroids (prednisone 5-60mg daily depending on severity), or disease-modifying antirheumatic drugs (DMARDs) like methotrexate (7.5-25mg weekly) for conditions like rheumatoid arthritis.
- Lifestyle Changes: Regular physical activity (30 minutes of moderate exercise 5 days weekly) helps maintain joint mobility and reduce inflammation, while an anti-inflammatory diet rich in omega-3 fatty acids, fruits, vegetables, and whole grains, and limited in processed foods, refined sugars, and red meat, can significantly reduce symptom severity.
- Biologic Therapies: Newer biologic therapies such as TNF inhibitors (adalimumab, etanercept) may be prescribed for moderate to severe cases that don't respond to conventional treatments, as shown in a study on ankylosing spondylitis where tumour necrosis factor blocking agents had a strong and fast effect on almost all aspects of active disease 1.
- Stress Management: Stress management through techniques like meditation, yoga, or deep breathing exercises is important as stress can trigger inflammatory flares.
Recent Evidence and Recommendations
- A 2024 study on ECCO guidelines for therapeutics in Crohn's disease suggests that exclusive enteral nutrition can be used as induction therapy in patients with mild-to-moderate CD who are motivated to adhere to dietary therapy, have access to dietetic support, and prefer to avoid corticosteroids 1.
- The same study highlights the importance of dietary intervention, with all patients with CD having access to dietary services, especially during disease flare, and notes that while there is no universally applicable diet, dietary therapies may be beneficial in reducing the inflammatory burden in CD.
- Another study from 2023 emphasizes the importance of pre-operative care in patients with inflammatory bowel disease, including nutritional status and psychological health, and suggests that prehabilitation and enhanced recovery after surgery (ERAS) protocols can improve outcomes 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Management of Chronic Inflammatory Diseases
- Chronic inflammatory diseases, such as rheumatoid arthritis and psoriatic arthritis, can be managed with disease-modifying anti-rheumatic drugs (DMARDs) like methotrexate 2, 3, 4
- Methotrexate has been shown to be effective in reducing disease activity and improving function in patients with rheumatoid arthritis and psoriatic arthritis 3, 4
- Combination therapy with methotrexate, sulfasalazine, and hydroxychloroquine may also be effective in treating rheumatoid arthritis 2
- Dietary interventions, such as high-fiber plant-based diets, may also help reduce inflammation and improve disease outcomes in patients with chronic inflammatory diseases 5
- Lifestyle interventions, including regular physical exercise, body weight management, and healthy dietary patterns, may also be beneficial in preventing and treating hypertension, a common comorbidity with chronic inflammatory diseases 6
Treatment Options
- Methotrexate is a commonly used DMARD for the treatment of rheumatoid arthritis and psoriatic arthritis 3, 4
- The efficacy and safety of methotrexate have been confirmed in several studies, with a survival rate of approximately 60% at 24 months of follow-up 3
- Combination therapy with methotrexate and other DMARDs may be considered for patients who do not respond to methotrexate alone 2
- Dietary interventions and lifestyle modifications may be used in conjunction with pharmacological treatments to manage chronic inflammatory diseases 5, 6
Future Directions
- Further research is needed to fully understand the effects of dietary interventions and lifestyle modifications on chronic inflammatory diseases 5, 6
- The development of new treatments and therapies for chronic inflammatory diseases is ongoing, and may include the use of biotechnological drugs and other novel agents 3