Review article: moving towards common therapeutic goals in Crohn's disease and rheumatoid arthritis

• Published in: Alimentary Pharmacology & Therapeutics (Suppl) Vol. 45; no. 8; pp. 1058 - 1072
• Main Authors: Allen, P. B., Olivera, P., Emery, P., Moulin, D., Jouzeau, J.‐Y., Netter, P., Danese, S., Feagan, B., Sandborn, W. J., Peyrin‐Biroulet, L.
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.04.2017
• Subjects: Antibodies, Monoclonal, Humanized - therapeutic use; Arthritis, Rheumatoid - drug therapy; Clinical trials; Crohn Disease - drug therapy; Crohn's disease; Crohns disease; Damage prevention; Disease Progression; Goals; Human health and pathology; Humans; Hépatology and Gastroenterology; Intestine; Life Sciences; Monoclonal antibodies; Mucosa; Patient Care Planning - trends; Prospective Studies; Remission; Rheumatoid arthritis; Rhumatology and musculoskeletal system; Ustekinumab - therapeutic use
• ISSN: 0269-2813; 0953-0673; 1365-2036
• DOI: 10.1111/apt.13995

Summary Background Crohn's disease (CD) and rheumatoid arthritis are chronic, progressive and disabling conditions that frequently lead to structural tissue damage. Based on strategies originally developed for rheumatoid arthritis, the treatment goal for CD has recently moved from exclusively controlling symptoms to both clinical remission and complete mucosal healing (deep remission), with the final aim of preventing bowel damage and disability. Aim To review the similarities and differences in treatment goals between CD and rheumatoid arthritis. Methods This review examined manuscripts from 1982 to 2016 that discussed and/or proposed therapeutic goals with their supportive evidence in CD and rheumatoid arthritis. Results Proposed therapeutic strategies to improve outcomes in both rheumatoid arthritis and CD include: (i) evaluation of musculoskeletal or organ damage and disability, (ii) tight control, (iii) treat‐to‐target, (iv) early intervention and (v) disease modification. In contrast to rheumatoid arthritis, there is a paucity of disease‐modification trials in CD. Conclusions Novel therapeutic strategies in CD based on tight control of objective signs of inflammation are expected to change disease course and patients’ lives by halting progression or, ideally, preventing the occurrence of bowel damage. Most of these strategies require validation in prospective studies, whereas several disease‐modification trials have addressed these issues in rheumatoid arthritis over the last decade. The recent approval of new drugs in CD such as vedolizumab and ustekinumab should facilitate initiation of disease‐modification trials in CD in the near future.