introduction

Crohn's disease is a so-called chronic inflammatory bowel disease, or IBD for short. It runs in spurts and is not curable. Therefore, those affected are usually forced to take medication for their entire life in order to prevent new flare-ups from occurring (maintenance of remission).

While cortisone was the only known drug for the treatment of Crohn's disease a few decades ago, today we have a large number of different groups of active substances that are suitable for treating an acute flare-up, maintaining remission or, in some cases, both.

Read more on this topic: Therapy of Crohn's disease

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What drug groups are there?

As already mentioned, a distinction is made between drugs for treating an acute attack and drugs for maintaining remission.

Cortisone preparations still play a major role in acute treatment, but their use in long-term therapy is prohibited due to the potentially severe side effects. In contrast to the closely related mesalazine (5-ASA), the active ingredient sulfasalazine has also established itself in the treatment of relapses in Crohn's disease.

Antibiotics are also used successfully to treat flare-ups; metronidazole and ciprofloxacin are the drugs of choice.

Immunomodulators from the group of TNF blockers (adalimumab, infliximab) are also used in the case of very severe attacks or those that cannot be otherwise controlled. Ultimately, an acute episode may require surgical intervention.

To Remission maintenance, so in the Long term therapy, is the active ingredient especially in previously operated patients Mesalazine (5-ASA) is used.

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Often this drug alone is not enough. Then come Immunosuppressants used, but possibly with severe side effects can go hand in hand, which is why regular checks are essential. Here have themselves Methotrexate, Azathioprine and the closely related 6-mercaptopurine established. An alternative to these immunosuppressants are the TNF blockers (infliximab, adalimumab), which are also used in acute therapy, but which also have undesirable side effects in long-term therapy allergic reaction or Changes in blood count can trigger.

The active ingredients have been newly approved for maintaining remission in Crohn's disease Vedolizumab, a so-called Integrin antagonist, and Ustekinumab, a Interleukin antagonist. Because of their timeliness few experiences yet from long-term treatment.

Cortisone therapy

Cortisone is used in Crohn's disease especially for the treatment of acute relapses for use. It can be systemic as a tablet or in in some cases also locally as an enema or enema.

With light to medium attacks almost always lead to cortisone supplements Improvement of the complaints. Even the most severe flare-ups can be brought under control in around half of the cases. As soon as the thrust is over, you should try that Stop taking cortisone again and instead use other drugs that are better suited for long-term therapy.

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Otherwise, cortisone can be one of those used for glucocorticoids typical side effects lead: Weight gain occurs, especially through Storage of water in the tissue (edema). It can also, among other things Bone loss (osteoporosis), Weakening of the immune system and creation of a Diabetes mellitus (Steroid diabetes) come.

At local application Much less cortisone gets into the bloodstream, which is why it too fewer side effects comes. However, cortisone is even in local form not for long-term therapy suitable because the side effects can still occur at some point.

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Azathioprine

The active substance Azathioprine is a so-called Immunosuppressant. That is, it reduces the function of the immune system.

This effect is used in the therapy of Crohn's disease, as is the case with the Inflammation in the intestines is reduced becomes. This is achieved by using the Multiplication of certain attack cells of the immune system stopped becomes. Therefore azathioprine is also called so-called Cytostatic classified.

The Side effects of azathioprine are relative unspecificso it can be among other things Hair loss, increased risk of infection, nausea, Vomit, diarrhea, Weight loss, fever, Joint pain and Changes in blood count to lead. It can also teratogenic work, which is why it is of Not ingested for pregnant women should be.

Because of this large number of possible side effects, the therapy with azathioprine always below close medical supervision. Nevertheless, it is suitable for long-term therapy of Crohn's disease because that Risk of side effects with good medical supervision low is.

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Biologics

Biologicals (also called biologicals or biopharmaceuticals) are drugs that are very similar to or resemble the body's own proteins. In the case of Crohn's disease, for example, antibodies are used that attack specific cells or just molecules in the body and thus fight the inflammation.

Mainly adalimumab and infliximab are used, both of which are directed against the inflammatory mediator TNF.

The drugs vedolizumab, an antibody against a certain protein of some immune cells, and ustekinumab, which is directed against the inflammation mediators interleukin-12 and interleukin-23, are also newly approved. Since these two biologics have only recently been on the market, there is little data available on the long-term effects or side effects of prolonged use.

The advantage of all the biologics mentioned is that they have relatively few side effects, as they only have a very specific target in the body and, in the best case, do not affect other cells and molecules. However, antibodies can also trigger specific side effects.

An important side effect is the possible occurrence of allergic reactions. Biologics are usually made by other organisms and are of non-human origin. This can lead to immune reactions against the "foreign" structures.

Read more on the subject at: Biologics

Drugs in remission

To maintain remission one uses Medicationthat are in the Long term therapy over years or decades acceptable low side effects to have. Regular medical check-ups, often with monitoring of the blood count, are nevertheless always necessary in order to avoid fluctuations in the level of active substances in the blood.

Often used here Immunosuppressantswho have favourited active ingredients Methotrexate, Azathioprine and 6-mercaptopurine are approved for the treatment of Crohn's disease. Especially with long-term immunosuppressive treatment Blood count checks essentialas these drugs act on the blood-forming system of the bone marrow.

As an alternative, antibodies can also be used. Here are Infliximab and Adalimumab from the group of TNF blockers, the integrin antagonist Vedolizumab and the interleukin antagonist Ustekinumab authorized.

The drug Mesalazine, an integral part of almost every long-term therapy for the closely related disease Ulcerative colitis is unfortunately seems ineffective in long-term therapy for Crohn's disease to be. Only previously operated patients benefit from it.

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Medicines for joint pain in Crohn's disease

Joint pain is one frequent accompaniment of Crohn's disease. Sometimes the joints are also inflamed (arthritis), but it happens more often Joint pain with no signs of inflammation.

In the acute episode, the larger joints are usually affected, while in the remission it is the small joints in particular that cause problems. Unfortunately it is forbidden to take the usual anti-rheumatic pain relievers (e.g. Diclofenac) in the presence of Crohn's disease, as this can have a relapsing effect. Are better suited here Paracetamol and Metamizole.

To that Recurrence of pain to prevent, should primarily be the Self-treated Crohn's disease become. If the pain persists despite a well-controlled underlying disease, you must start with a antirheumatic therapy can be started, for example with Methotrexate (first choice), the one actually used for malaria treatment Chloroquine or. Hydroxychloroquine, Leflunomide or Sulfasalazine.

If there is still no improvement, TNF antibodies (infliximab and adalimumab) are used as in the basic therapy for Crohn's disease. However, as an undesirable side effect, these TNF antibodies can also lead to joint pain themselves.

Can you treat Crohn's disease without medication?

Crohn's disease is a systemic disease that can be severe. As such, it is treated in conventional medicine with very strong drugs, the possible side effects of which make many sufferers shy away.

The temptation, alternative therapies of some "miracle healers"who advertise a complete cure for the disease is understandably great. Still must of this strongly discouraged become. There is no therapy whose effectiveness is proven to be greater than that of drug treatment.

Alternative procedures like homeopathic remedies or very special diet plans should, if only supportive be used for pharmacological therapy.

Medicines may never be discontinued without authorization. Otherwise, permanent inflammation can and will be Permanently damage the digestive tract. Fistulas, scarring, abscesses, intestinal obstruction, intestinal perforations and an increased risk of colon cancer are the result. A life-threatening spread of the inflammation to the entire body is also absolutely conceivable.


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