Anti-TNF antibody treatment of Crohn's disease

Abstract

The incidence of Crohn's disease is increasing in Western Europe and the USA, and is now 6–10/100 000 inhabitants.12 13Because Crohn's disease is a lifetime disorder, the prevalence is at least 20-fold higher. The clinical symptoms and signs of Crohn's disease can be rather non-specific, including abdominal pain, weight loss, fatigue and (bloody) diarrhoea, but most patients with active disease have an increased erythrocyte sedimentation rate (ESR) or raised circulating C reactive protein concentrations. Although commonly known as “terminal ileitis”, only about 30% of patients have disease restricted to the terminal ileum, and most patients have isolated large bowel, or combined small and large bowel involvement. The disease may also involve the oral cavity, oesophagus and stomach, and can occur outside the intestinal tract, in particular in the perineal area (histologically characterised by granulomatous lymphangitis) or located in surgical wounds. About 20% of patients have perianal fistulas, and the presence of such lesions is a substantial risk factor for eventual complete loss of the large bowel and construction of a permanent ileostoma.14 Lifestyle factors may have an important impact on disease activity, and smoking of cigarettes worsens disease activity and leads to frequent relapses (interestingly, in ulcerative colitis smoking is protective).15-17