Step I Mesalamine for IBD

[HereWeGo21]

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Say a patient has IBD, and also gastric ulcers.

Would mesalamine be contraindicated? Because it's a 5-ASA derivative. And I know aspirin would be contraindicated in peptic ulcers.

But I got a Kaplan question that discusses treating someone with peptic ulcer disease with mesalamine.

 

[walakin25]

it is activated by colonic flora

 

[Phloston]

Say a patient has IBD, and also gastric ulcers.

Would mesalamine be contraindicated? Because it's a 5-ASA derivative. And I know aspirin would be contraindicated in peptic ulcers.

But I got a Kaplan question that discusses treating someone with peptic ulcer disease with mesalamine.

Per rectum administration of 5-ASA, mesalamine and steroids can be done for IBD. It really depends on the patient and how severe/distal the disease is. Some of the newer preparations bear decreased jejunal absorption so that they function primarily in the colon.

 

[HereWeGo21]

Per rectum administration of 5-ASA, mesalamine and steroids can be done for IBD. It really depends on the patient and how severe/distal the disease is. Some of the newer preparations bear decreased jejunal absorption so that they function primarily in the colon.

Alright, cool, thanks, that helps.

Another thing, though: this question implied that Mesalamine can be a DMARD for treatment of rheumatoid arthritis? This was strange to me as I thought 5-ASA wouldn't be systemically bioavailable.

 

[Phloston]

Alright, cool, thanks, that helps.

Another thing, though: this question implied that Mesalamine can be a DMARD for treatment of rheumatoid arthritis? This was strange to me as I thought 5-ASA wouldn't be systemically bioavailable.

I quite honestly can't comment on mesalamine for RA, but at this point in time/medicine, methotrexate is the gold standard first-line DMARD for RA. If Sx are refractory, you add an anti-TNF biologic (e.g., infliximab, adalimumab, etanercept, golimumab, certolizumab pegol).