When you’re living with a chronic condition like Crohn’s disease, it makes sense that you’d focus on how you’re doing right now before deciding whether you need to make any changes to your treatment. But if you only pay attention to current symptoms and disease activity, you might not be getting enough treatment that’s aggressive enough to protect your health in the future.

At the Advances in Inflammatory Bowel Disease (AIBD) meeting this week, researcher David T. Rubin, MD, of the University of Chicago, suggested that some Crohn’s disease patients are undertreated because their physicians concentrate mostly on current symptoms and disease activity when making treatment decisions.

While it’s crucial to monitor disease activity and understand how Crohn’s is impacting your weight, development, digestion, and overall health, Rubin believes that a patient’s prognosis must be factored in too.

Someone who’s doing well right now might still have a poor prognosis because of factors including smoking status, age at diagnosis (developing Crohn’s at a younger age is more dangerous), and the presence of infected tunnels (fistulas) around the anus.

“If you have a patient in your office who is in remission today but has severe disease or a poor prognosis because of risk factors, you’re taking a chance by waiting for the patient to fail a therapy [rather than advance to the next treatment option]. That’s not how we should be managing chronic progressive disease,” Dr. Rubin said at the AIBD meeting, according to a MedPage Today report.

Dr. Rubin further clarified that the treatment target for every patient should be different, and that frequent assessments and adjustments in treatment for Crohn’s disease are often necessary.

The flip side of under-treatment, said Dr. Rubin, is overtreatment with drugs. He said some patients are kept on steroid drugs too long, while others try medication after medication when they really ought to turn to surgery sooner. Dr. Rubin also warned that doctors shouldn’t use a combination of medications when one drug alone is sufficient. For instance, he explained that most patients using the drug infliximab (Remicade) alone do just as well as those taking infliximab plus azathioprine (Imuran or Azasan).

“Keep in mind that if you’re using unnecessary combination approaches, you will also be exposing the patient to more adverse events,” said Dr. Rubin, according to MedPage Today.

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