What physical exam is needed at 6-month check-ups for a patient with Crohn's disease in remission on Humira (adalimumab)?

From the Guidelines

A comprehensive physical examination is necessary at 6-month check-ups for a patient with Crohn's disease in remission on Humira (adalimumab), focusing on vital signs, abdominal examination, perianal inspection, and assessment for extraintestinal manifestations. This approach is supported by the Canadian Association of Gastroenterology clinical practice guideline for the management of luminal Crohn's disease 1, which emphasizes the importance of monitoring disease activity and potential complications. The physical examination should include:

• Vital signs to monitor for any signs of infection or inflammation
• Abdominal examination to assess for tenderness, masses, and hepatosplenomegaly
• Perianal inspection to detect fistulas or abscesses that may develop even during apparent remission
• Assessment for extraintestinal manifestations, such as skin, eye, and joint involvement
• Documentation of weight and nutritional status to monitor for malabsorption issues
• General assessment for lymphadenopathy and signs of infection, given the immunosuppressive effects of adalimumab

According to the guideline on optimising monitoring in the management of Crohn's disease 1, patients with Crohn's disease in remission should be evaluated for symptomatic response to therapy and have laboratory parameters, such as complete blood count, liver profile, and fecal calprotectin, checked every 3-12 months. The physical examination should be complemented by laboratory tests and fecal calprotectin measurement to provide a complete assessment of disease activity and treatment response. By prioritizing a comprehensive physical examination and regular monitoring, healthcare providers can detect early disease recurrence or complications and optimize treatment outcomes for patients with Crohn's disease in remission on Humira (adalimumab) 1.

From the Research

Physical Exam at 6-Month Check-Ups for Crohn's Disease Patients

• A physical exam is necessary at 6-month check-ups for patients with Crohn's disease, even if they are in remission on Humira (adalimumab) 2.
• The physical exam should include:
  • Anorectal examination to check for any signs of active disease or complications 2.
  • Assessment for extraintestinal complications, such as joint pain or skin rashes 2.
  • Evaluation of overall health and well-being, including weight, blood pressure, and abdominal examination 2.

Components of the Physical Exam

• The physical exam should focus on identifying any signs of active disease, such as:
  • Abdominal tenderness or pain 2.
  • Weight loss or gain 2.
  • Fatigue or lethargy 2.
• The exam should also assess for any potential complications of Crohn's disease, such as:
  • Osteoporosis or osteopenia 2.
  • Anemia or other nutritional deficiencies 2.
  • Depression or anxiety 2.

Importance of Regular Check-Ups

• Regular 6-month check-ups are crucial for patients with Crohn's disease, even if they are in remission on Humira (adalimumab) 2.
• These check-ups allow healthcare providers to:
  • Monitor disease activity and adjust treatment as needed 3, 4, 5.
  • Screen for potential complications and prevent them from becoming severe 2.
  • Provide ongoing education and support to patients to manage their condition effectively 2.