New IBD markers: definition of disease heterogeneity

  • S. R. Targan


The objective of this chapter is to relate recent findings that support the use of molecular and cellular techniques to define subsets of patients with inflammatory bowel disease (IBD). An example of the potential of using these methods to define disease subgroups by genetic and subclinical markers is an ‘aggressive’ form of rheumatoid arthritis, which recently has been shown to express a specific HLA-DR4 allele1. This subgroup of patients with rheumatoid arthritis is defined clinically by a progressively active course that is resistant to standard therapy, including corticosteroids. Such patients do, however, respond very well to treatment with the immune suppressant, methotrexate. Those patients with the HLA-DR4 allele are now placed immediately on methotrexate. Thus, this description of a subgroup of patients has led to a completely altered treatment protocol, and is the first instance where a genetic marker is being used to define a subset of patients for treatment with a selected therapy in an immunologically mediated disease. In ulcerative colitis and Crohn’s disease, subsets of patients may also be defined by genetic and subclinical markers that reflect specific types of mucosal inflammation, and each type may represent a unique opportunity for individualized treatment approaches.


Ulcerative Colitis Patient Juvenile Rheumatoid Arthritis Antineutrophil Cytoplasmic Antibody Pouchitis Disease Activity Index Individualize Treatment Approach 
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© Kluwer Academic Publishers and Axcan Pharma, Inc. 1994

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  • S. R. Targan

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