Potential monitoring of a patient with clinically active CD
| Question | Monitoring tool | Prediction |
|---|---|---|
| Are there endoscopic active lesions? | CRP ≤5 mg/l and faecal calprotectin ≤200 μg/g MR enterocolonography (MaRIA score) | Predicts CDEIS ≤6 with a sensitivity of 83% and specificity of 71%57 Predicts active endoscopic ileocolonic lesions with a sensitivity of 87% and a specificity of 89%30 31 |
| Is the patient going to respond to anti-TNF therapy (before induction)? | CRP >5 mg/l Presence of any ulcer at ileocolonoscopy | 76% response rate after first anti-TNF (compared with 46% when normal CRP)54 61% steroid-free remission with azathioprine+infliximab combination therapy (compared with 40% without endoscopic lesion)13 |
| Is the patient going to respond to anti-TNF therapy (after induction)? | Faecal calprotectin decrease Absence of sustained CRP normalisation | Increased proportion of endoscopic healing58 Increased risk of anti-TNF loss of response59 |
CD, Crohn's disease; CDEIS, CD Endoscopic Index of Severity; CRP, C-reactive protein; MaRIA, Magnetic Resonance Index of Activity; TNF, tumour necrosis factor.