From the Guidelines
When evaluating a patient with Crohn's disease, it is crucial to ask about their health-related quality of life, symptom-specific anxieties, early life adversity, and functional impairment related to their digestive symptoms, as these factors can significantly impact their disease course and treatment outcomes. According to the study by 1, assessing health-related quality of life can be done informally and briefly using open-ended questions, such as "How do your bowel symptoms interfere with your ability to do what you want to do in your daily life?" and "What areas of your life are affected most?" These questions can help identify key areas where targeted medical intervention can be of greatest help for restoring satisfactory life functioning. Additionally, inquiring about early life adversity, such as physical, emotional, or sexual abuse, can help identify critical factors affecting the onset and expression of functional GI disorder symptoms and point out which patients would benefit from psychological intervention earlier on in care. Asking about symptom-specific anxiety can also amplify disease burden and lead to higher health care utilization, and can be uncovered by asking a simple and direct open-ended question: "What worries or concerns do you have about your symptoms?" It is also important to discuss their current medications, disease history, and family history of inflammatory bowel disease or colorectal cancer, as well as their smoking status, as smoking can worsen the disease course and increase the risk of surgery and complications, as noted in the study by 1. Some key questions to ask include:
- How do your bowel symptoms interfere with your daily life?
- What areas of your life are affected most by your symptoms?
- What worries or concerns do you have about your symptoms?
- Have you experienced any early life adversity, such as physical, emotional, or sexual abuse?
- What is your current smoking status, and have you been advised to quit smoking?
- How has your disease affected your relationships, work, and mental health? These questions can help assess disease activity, treatment effectiveness, and the overall impact on the patient's life, allowing for appropriate management adjustments and comprehensive care.
From the FDA Drug Label
INDICATIONS AND USAGE REMICADE is a tumor necrosis factor (TNF) blocker indicated for: Crohn's Disease: reducing signs and symptoms and inducing and maintaining clinical remission in adult patients with moderately to severely active disease who have had an inadequate response to conventional therapy.
To ask a patient with Crohn's disease, consider the following:
- Current symptoms: Ask about the severity of their symptoms, such as abdominal pain, diarrhea, and weight loss.
- Treatment history: Inquire about their previous treatments, including any conventional therapies they have tried and their response to these treatments.
- Disease activity: Assess the current activity of their disease, including the frequency and severity of flare-ups.
- Quality of life: Discuss how their Crohn's disease is affecting their daily life, including their ability to work, eat, and participate in activities.
- Medication adherence: Ask about their adherence to their current medication regimen and any concerns they may have about their treatment.
- Previous infections: Inquire about any previous infections, including tuberculosis, and whether they have been tested for latent TB.
- Family history: Ask about any family history of lymphoma or other malignancies. 2
From the Research
Patient Assessment
When assessing a patient with Crohn's disease, it is essential to consider the following factors:
- Symptoms: abdominal pain, diarrhea, fever, malaise, and arthralgias 3
- Disease severity: mild, moderate, or severe 3, 4
- Medical history: previous treatments, surgeries, and comorbid conditions 4
- Lifestyle factors: smoking status, diet, and physical activity level 4, 5
- Laboratory results: inflammation markers, fecal calprotectin, and complete blood count 4
Treatment Options
Treatment for Crohn's disease depends on the severity of the disease and the patient's response to previous treatments:
- Mild to moderate disease: salicylates, antibiotics, and aminosalicylates 3, 6
- Moderate to severe disease: corticosteroids, immunomodulators, and biologics 3, 4, 6, 7
- Severe or refractory disease: infliximab and other anti-TNF agents 3, 6
Monitoring and Follow-up
Regular monitoring and follow-up are crucial to manage Crohn's disease effectively: