Ulcerative colitis clinical presentation

Clinical Use. Azathioprine (Imuran) is a cytotoxic agent that is structurally and functionally similar to certain anticancer drugs, such as mercaptopurine.22,30 Azathioprine is primarily used to prevent the rejection of transplanted organs, especially in patients with kidney transplants. Azathioprine may also be used to suppress immune responses in a wide range of other conditions, such as systemic lupus erythematosus, dermatomyositis, inflammatory myopathy, hepatic disease, myasthenia gravis, and ulcerative colitis. As presented in Chapter 16, azathioprine is also used as an antiarthritic disease-modifying agent. 

Meyers S, Sachar DB, Present DH, Janowitz HD. Olsalazine sodium in the treatment of ulcerative colitis among patients intolerant of sulfasalazine. A prospective, randomized, placebo-controlled, double-blind, doseranging clinical trial. Gastroenterology 1987 93(6) 1255-62. 

Corticosteroids should only be used during acute exacerbations of ulcerative colitis. The total duration of therapy should not exceed 4 to 8 weeks. Many different corticosteroids are available and differ in anti-inflammatory potency and mineralocorticoid activity (Table 38-2). Choosing a corticosteroid and route of administration depends on the clinical presentation. 

Paradoxical inflammation such as psoriasis is a well-known phenomenon of anti-TNFa therapy approved for the treatment of autoimmxme diseases such as rheumatoid arthritis, Crohn s disease, ulcerative colitis and psoriasis. Likewise, infliximab is used to treat refractory sarcoidosis but recently a case of infliximab-induced cutaneous sarcoidosis was reported in a patient with ulcerative colitis [150 ]. The induction of psoriasis and other clinical presentations like psoriasiform exanthema and palmoplantar pustulosis as side effects of infliximab treatment is not xmderstood and the pathogenesis of such reactions has been further obscured by the finding of a patient with Crohn s disease who developed arthritis as well as the skin manifestations cf psoriasis after the administration of infliximab [151 ]. 

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