Ustekinumab and Surgical Resection in Synchronous Rheumatoid Arthritis , Sjögren's syndrome and Pan-Colitis of Crohn’s Disease
EAES Academy. Chen C. 07/05/22; 362977; P020
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Abstract
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Aims :
Biological agent has been used in various autoimmune diseases more than 15 years. Patients with rheumatoid arthritis (RA) , Sjögren's syndrome (SS), ulcerative colitis (UC) and Crohn’s disease (CD) could be beneficial for joint pain relief, gastrointestinal upset resolution, renal function preservation , and life quality improvement. New biological agents are rapidly being introduced years by years.
Method :
We presented treatment course on a patient with synchronous multiple autoimmune disease of RA, SS , and colonic CD . The previous biological agent and oral corticosteroids did not suppress inflammatory status of lower gastrointestinal tract . The patient suffered a critical episode of colonic Crohn’s disease perforations at ascending and sigmoid colon . We resected the diseased segment of colon with temporary end ileostomy, then applied ustekinumab for maintenance her bowel function, and record a series of neurophil-lymphocyte ratio (NLR) as evaluation tool of biological effectiveness on multiple autoimmune disease.
Results :
This 58 years-old female patient had RA diagnosed at age 28, and subsequent SS and CD noted for more than 16 years with regular corticosteroids imuran and selective , B-cell depleting biologic agent treatment ( rituximab since 2017), failure 14 months later, then shifting to tocilizumab until now. She had acute on chronic abdominal pain, then visited emergent room, elevated WBC up to 11560 m/L and CT of abdomen showed multiple site colon wall thickening and moderate ascites. After emergent resection for skip lesion of pan-colitis Crohn’s disease and application of ustekinumab , the patient had well appetite , body weight gain, and life quality. The NLR had positive response after operation and ustekinumab with 2-months observation. We would like to reconstruct the bowel in the future.
Conclusion :
Same as SNQ awarded experience, we emphasized the cooperation between gastrointestinal surgeons, ostomy and wound nursing care, parenteral or enteral nutritional supplement, social workers that made patient recovery soon in mood and physical field. The ustekinumab provided rapid and sustainable improvement in bowel function and symptomatic relief for patient with synchronous multiple immune disease , RA, SS and CD in every 8 weeks medication. The safety profile of ustekinumab is consistent with that of other immuno-modulator agent. The long term efficacy of ustekinumab is still going on evaluation in patients with multiple autoimmune disease.
Biological agent has been used in various autoimmune diseases more than 15 years. Patients with rheumatoid arthritis (RA) , Sjögren's syndrome (SS), ulcerative colitis (UC) and Crohn’s disease (CD) could be beneficial for joint pain relief, gastrointestinal upset resolution, renal function preservation , and life quality improvement. New biological agents are rapidly being introduced years by years.
Method :
We presented treatment course on a patient with synchronous multiple autoimmune disease of RA, SS , and colonic CD . The previous biological agent and oral corticosteroids did not suppress inflammatory status of lower gastrointestinal tract . The patient suffered a critical episode of colonic Crohn’s disease perforations at ascending and sigmoid colon . We resected the diseased segment of colon with temporary end ileostomy, then applied ustekinumab for maintenance her bowel function, and record a series of neurophil-lymphocyte ratio (NLR) as evaluation tool of biological effectiveness on multiple autoimmune disease.
Results :
This 58 years-old female patient had RA diagnosed at age 28, and subsequent SS and CD noted for more than 16 years with regular corticosteroids imuran and selective , B-cell depleting biologic agent treatment ( rituximab since 2017), failure 14 months later, then shifting to tocilizumab until now. She had acute on chronic abdominal pain, then visited emergent room, elevated WBC up to 11560 m/L and CT of abdomen showed multiple site colon wall thickening and moderate ascites. After emergent resection for skip lesion of pan-colitis Crohn’s disease and application of ustekinumab , the patient had well appetite , body weight gain, and life quality. The NLR had positive response after operation and ustekinumab with 2-months observation. We would like to reconstruct the bowel in the future.
Conclusion :
Same as SNQ awarded experience, we emphasized the cooperation between gastrointestinal surgeons, ostomy and wound nursing care, parenteral or enteral nutritional supplement, social workers that made patient recovery soon in mood and physical field. The ustekinumab provided rapid and sustainable improvement in bowel function and symptomatic relief for patient with synchronous multiple immune disease , RA, SS and CD in every 8 weeks medication. The safety profile of ustekinumab is consistent with that of other immuno-modulator agent. The long term efficacy of ustekinumab is still going on evaluation in patients with multiple autoimmune disease.
Aims :
Biological agent has been used in various autoimmune diseases more than 15 years. Patients with rheumatoid arthritis (RA) , Sjögren's syndrome (SS), ulcerative colitis (UC) and Crohn’s disease (CD) could be beneficial for joint pain relief, gastrointestinal upset resolution, renal function preservation , and life quality improvement. New biological agents are rapidly being introduced years by years.
Method :
We presented treatment course on a patient with synchronous multiple autoimmune disease of RA, SS , and colonic CD . The previous biological agent and oral corticosteroids did not suppress inflammatory status of lower gastrointestinal tract . The patient suffered a critical episode of colonic Crohn’s disease perforations at ascending and sigmoid colon . We resected the diseased segment of colon with temporary end ileostomy, then applied ustekinumab for maintenance her bowel function, and record a series of neurophil-lymphocyte ratio (NLR) as evaluation tool of biological effectiveness on multiple autoimmune disease.
Results :
This 58 years-old female patient had RA diagnosed at age 28, and subsequent SS and CD noted for more than 16 years with regular corticosteroids imuran and selective , B-cell depleting biologic agent treatment ( rituximab since 2017), failure 14 months later, then shifting to tocilizumab until now. She had acute on chronic abdominal pain, then visited emergent room, elevated WBC up to 11560 m/L and CT of abdomen showed multiple site colon wall thickening and moderate ascites. After emergent resection for skip lesion of pan-colitis Crohn’s disease and application of ustekinumab , the patient had well appetite , body weight gain, and life quality. The NLR had positive response after operation and ustekinumab with 2-months observation. We would like to reconstruct the bowel in the future.
Conclusion :
Same as SNQ awarded experience, we emphasized the cooperation between gastrointestinal surgeons, ostomy and wound nursing care, parenteral or enteral nutritional supplement, social workers that made patient recovery soon in mood and physical field. The ustekinumab provided rapid and sustainable improvement in bowel function and symptomatic relief for patient with synchronous multiple immune disease , RA, SS and CD in every 8 weeks medication. The safety profile of ustekinumab is consistent with that of other immuno-modulator agent. The long term efficacy of ustekinumab is still going on evaluation in patients with multiple autoimmune disease.
Biological agent has been used in various autoimmune diseases more than 15 years. Patients with rheumatoid arthritis (RA) , Sjögren's syndrome (SS), ulcerative colitis (UC) and Crohn’s disease (CD) could be beneficial for joint pain relief, gastrointestinal upset resolution, renal function preservation , and life quality improvement. New biological agents are rapidly being introduced years by years.
Method :
We presented treatment course on a patient with synchronous multiple autoimmune disease of RA, SS , and colonic CD . The previous biological agent and oral corticosteroids did not suppress inflammatory status of lower gastrointestinal tract . The patient suffered a critical episode of colonic Crohn’s disease perforations at ascending and sigmoid colon . We resected the diseased segment of colon with temporary end ileostomy, then applied ustekinumab for maintenance her bowel function, and record a series of neurophil-lymphocyte ratio (NLR) as evaluation tool of biological effectiveness on multiple autoimmune disease.
Results :
This 58 years-old female patient had RA diagnosed at age 28, and subsequent SS and CD noted for more than 16 years with regular corticosteroids imuran and selective , B-cell depleting biologic agent treatment ( rituximab since 2017), failure 14 months later, then shifting to tocilizumab until now. She had acute on chronic abdominal pain, then visited emergent room, elevated WBC up to 11560 m/L and CT of abdomen showed multiple site colon wall thickening and moderate ascites. After emergent resection for skip lesion of pan-colitis Crohn’s disease and application of ustekinumab , the patient had well appetite , body weight gain, and life quality. The NLR had positive response after operation and ustekinumab with 2-months observation. We would like to reconstruct the bowel in the future.
Conclusion :
Same as SNQ awarded experience, we emphasized the cooperation between gastrointestinal surgeons, ostomy and wound nursing care, parenteral or enteral nutritional supplement, social workers that made patient recovery soon in mood and physical field. The ustekinumab provided rapid and sustainable improvement in bowel function and symptomatic relief for patient with synchronous multiple immune disease , RA, SS and CD in every 8 weeks medication. The safety profile of ustekinumab is consistent with that of other immuno-modulator agent. The long term efficacy of ustekinumab is still going on evaluation in patients with multiple autoimmune disease.
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