Inflammatory bowel diseases (IBD) such as ulcerative colitis and Crohn's disease lead to altered gastrointestinal (GI) function as a consequence of the effects of inflammation on the tissues that comprise the GI tract. Among these tissues are several types of neurons that detect the state of the GI tract, transmit pain, and regulate functions such as motility, secretion, and blood flow. This review article describes the structure and function of the enteric nervous system, which is embedded within the gut wall, the sympathetic motor innervation of the colon and the extrinsic afferent innervation of the colon, and considers the evidence that colitis alters these important sensory and motor systems. These alterations may contribute to the pain and altered bowel habits that accompany IBD.
Top four biologics used across the two patient groups: etanercept (33%)/adalimumab (30%)/tocilizumab (9%)/certolizumab pegol (7%). Current lab values/disease severity measures: ESR (mm/h) 21.7/23.2; CRP (mg/l) 10.3/10.3; rheumatoid factor (positive) 84%/87%; anti-CCP (positive) 70%/80%; current disease stage per physician judgment: mild 65%/52%, moderate 32%/40%, severe 3%/8%; mean VAS 3.4/3.6; mean HAQ 1.4/1.1; mean DAS 28 3.6/3.3; mean tender joint count 3.5/4.1; mean swollen joint count 2.4/2.6. ConClusions: In this cohort of RA patients in Europe, the majority of patients on monotherapy and combination therapy had mild disease per physician judgment and were on first-line biologic therapy. Lab measures and joint counts indicated only slightly higher disease burden among combination therapy patients. The impact of specific biologic treatments on observed patterns and the need for therapeutic sequencing may warrant further research.
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