From the Guidelines
The patient with an elevated C3 complement level of 1.8 g/L and a history of ulcerative colitis should undergo a comprehensive evaluation to determine if her ulcerative colitis is in an active flare, including stool studies for calprotectin, inflammatory markers like CRP and ESR, and potentially a colonoscopy if clinically indicated, as recommended by the AGA clinical practice guideline on the role of biomarkers for the management of ulcerative colitis 1.
This approach is supported by the guideline's suggestion to use a biomarker- and symptom-based monitoring strategy over a symptom-based monitoring strategy alone in patients with ulcerative colitis in symptomatic remission 1. The guideline also recommends using fecal calprotectin <150 mg/g, normal fecal lactoferrin, and/or normal CRP to rule out active inflammation and avoid routine endoscopic assessment of disease activity 1.
The patient's elevated C3 complement level indicates an acute phase reaction, which is a common finding during inflammatory processes, and may be related to active inflammation from her ulcerative colitis or another concurrent inflammatory condition.
Key points to consider in the management of this patient include:
- The use of biomarkers such as fecal calprotectin, fecal lactoferrin, and CRP to monitor disease activity and guide treatment decisions 1
- The importance of regular follow-up with gastroenterology to adjust therapy based on clinical response and laboratory parameters 1
- The potential benefits and harms of different treatment strategies, including the use of 5-aminosalicylates, corticosteroids, immunomodulators, and biologics 1
Overall, the management of this patient should be guided by the principles of personalized medicine, taking into account her individual clinical characteristics, preferences, and values, as well as the best available evidence from clinical research 1.
From the Research
Elevated C3 Complement in Ulcerative Colitis
- The patient's elevated C3 complement level of 1.8 g/L may be related to the underlying inflammatory process of ulcerative colitis (UC) 2.
- UC is a chronic idiopathic inflammatory bowel disorder characterized by continuous mucosal inflammation extending from the rectum to the more proximal colon 2.
- The disease is often associated with an increased risk of colorectal cancer, and chronic inflammation may contribute to this risk 3.
Treatment and Management of Ulcerative Colitis
- The goals of treatment in UC are to improve quality of life, achieve steroid-free remission, and minimize the risk of cancer 2.
- Treatment options for UC include 5-aminosalicylic acid (5-ASA) compounds, which are considered the first-line therapy for mild-to-moderate UC 4, 5.
- For patients with more extensive or severe disease, a combination of oral and topical 5-ASA drugs, corticosteroids, and/or biologic agents may be necessary to induce remission 2, 6.
Role of Immunomodulators in Ulcerative Colitis
- Immunomodulators, such as thiopurines and methotrexate, may be used in patients with milder disease who fail to maintain corticosteroid-free remission on aminosalicylates alone 6.
- However, the role of immunomodulators in UC is evolving, and their use may be restricted to specific patient populations due to concerns about safety and efficacy 6.