Thread by @shannonchangmd

@MondayNightIBD @DCharabaty @JanssenUS @pfizer @TakedaPharma 2/ 📸 Faculty disclosures & CME certification ℹ 👇
#CME certificate 🏅 → ℹ️ bit.ly/3GOowNG

@MondayNightIBD @DCharabaty @JanssenUS @pfizer @TakedaPharma 3/ 👌let's 🚴

In addition to 💉, pts w #IBD should undergo regular #PreventiveHealth #HCM:
📌Cancer Screening 🦀
📌Bone Health assessment 🦴
📌Mental Health 🥺
📌Treatment specific Testing 💉💊
📌Nutrition
📌Smoking cessation 🚬

#ICYMI vaccines #MNIBDTweetorial 📎 @🔚 of 🧵

@MondayNightIBD @DCharabaty @JanssenUS @pfizer @TakedaPharma 4/ 🧩Who is IS? #IBD pts on or had within last 3 months:
🚩 Prednisone > 20mg/day >2wks
🚩 AZA >2.5 mg/kg/day
🚩 6MP >1.5 mg/kg/day
🚩 MTX >0.4 mg/kg/week
🚩 Cyclosporine
🚩 Tacrolimus
🚩 Tofacitinib, ozanimod
🚩 TNFi, UST

Also:
🚩 Significant protein-calorie malnutrition

@MondayNightIBD @DCharabaty @JanssenUS @pfizer @TakedaPharma 5/ #PreConvo #IBDPoll #MondayNightIBD
🧩 28y/oM w #Crohns colitis >⅓ colon
🧩 x9yrs in clin & endo remission on IFX x5yrs
🧩Presents for f/up
🧩FCP 75. H/H nml. No FH of colon CA
🧩Last CLN 1y ago: endo + histologic remission

🗓️When do you rec timing of his colonoscopies?

@MondayNightIBD @DCharabaty @JanssenUS @pfizer @TakedaPharma 6/ Pts w #IBD have ⬆ risk of #ColonCancer

🔦Screening Recs
🧐 All pts w colitis >1/3 colon for ≥8yrs 👉 colonoscopy 🗓q1-3yrs
🧐 Frequency of 🔦depends on RF for CA: persistent 🔥, FH colon CA, h/o adenoma/dysplasia..
🧐 If #PSC start screening at time of dx & every year

@MondayNightIBD @DCharabaty @JanssenUS @pfizer @TakedaPharma 7/ Other #CancerScreening in #IBD

🧐Cervical: women on systemic IS 👉 cytology 🗓annually (if cytology alone) or 🗓q2y (if HPV➖)

@CrohnsColitisFn #MondayNightIBD

@MondayNightIBD @DCharabaty @JanssenUS @pfizer @TakedaPharma @CrohnsColitisFn 8/ 🧐Skin #CancerScreening in #IBD: all pts systemic IS 👉TBSE annually 🗓

🚨 IBD ⬆️risk of melanoma, antiTNFs may ⬆️risk
🚨Thiopurines 👉risk of non-melanoma skin cancer remains after cessation👉cont annual TBSE

🌞Prev: ⛱️ sun protection, 🧴sunscreen, 🧥☀️ protective clothing

@MondayNightIBD @DCharabaty @JanssenUS @pfizer @TakedaPharma @CrohnsColitisFn 9/ 🦴#BoneHealth in #IBD pts w ANY risk factors (see RF👇🏽) for osteoporosis

✅Central (hip & spine) DXA scan 🗓q5yrs.
✅Monitor VitD 25-OH
✅Rx calcium & VitD w each course oral steroids & if deficient
#MondayNightIBD

@MondayNightIBD @DCharabaty @JanssenUS @pfizer @TakedaPharma @CrohnsColitisFn 10/ 🚬 Cessation in #Crohns

#Smoking:
⬆ risk of #Crohns
⬆Extraintestinal manifestations
⬆Stricture
⬆Hospitalizations
👎Response to tx
⬆Surgeries & post-op recurrence

✅Assess 🚬 status at EVERY appt
💎Verbal/written edu + nicotine replacement tx 🔑🔓to quitting!

@MondayNightIBD @DCharabaty @JanssenUS @pfizer @TakedaPharma @CrohnsColitisFn 11/ 🔎 Screening for #MentalHealth

✅Anxiety & depression ⬆ in #IBD pts
🔁Bi-directional effect: Poor mental health 🔁 Poor disease control
⬆Depression (35%vs20%) & anxiety (66%vs28%) in active vs inactive IBD
✅Behavioral therapies & Meds: significantly ⬆QoL
#MondayNightIBD

@MondayNightIBD @DCharabaty @JanssenUS @pfizer @TakedaPharma @CrohnsColitisFn 12/ Screen all #IBD pts at baseline & annually🗓
👉PHQ9 (depression)
👉GAD7 (anxiety)

🗓️Keep an 👁️ for our #MNIBDTweetorial on #MentalHealth in #IBD w @DrTiffTaft in March

@MondayNightIBD @DCharabaty @JanssenUS @pfizer @TakedaPharma @CrohnsColitisFn @DrTiffTaft 13/ 🔎 Screen for #nutrientsdeficiency in #IBD
✅B12 if ileal disease or resection
✅Fe studies
✅Assess for malnutrition, diet limitations

🧒All peds pts 👉hgt wgt & BMI at EVERY visit🧒
#MondayNightIBD

@MondayNightIBD @DCharabaty @JanssenUS @pfizer @TakedaPharma @CrohnsColitisFn @DrTiffTaft 14/ 🏁 Before antiTNF
✅Latent TB
📌PPD or QuantiFeron-TB Gold assay
📌If high risk or indeterminate test 👉 chest X-ray
📌Clinical risk assess annually🗓

✅HepB serology
📌Start HBI 💉 series if needed
📌Verify HBsAb ++ post-vax

Screen/Monitor by Drug 👇 #MondayNightIBD

@MondayNightIBD @DCharabaty @JanssenUS @pfizer @TakedaPharma @CrohnsColitisFn @DrTiffTaft 15/ #PreConvo #IBDPoll #MondayNightIBD

Which of the following requires ECG prior to therapy initiation?

@MondayNightIBD @DCharabaty @JanssenUS @pfizer @TakedaPharma @CrohnsColitisFn @DrTiffTaft 16/ 🆕 Tx option in UC: ozanimod = S1P1 and S1P5 agonist

📌May cause transient change in HR at initiation ❤️
📌CI in pts w slow HR disorders
👉ECG to assess for preexisting ❤️ conduction abnormalities prior to tx

#MondayNightIBD

@MondayNightIBD @DCharabaty @JanssenUS @pfizer @TakedaPharma @CrohnsColitisFn @DrTiffTaft 17/ ✔️ Check list of screening & monitoring recommended by MOA 💉💊 of #IBD drugs

#MondayNightIBD

@MondayNightIBD @DCharabaty @JanssenUS @pfizer @TakedaPharma @CrohnsColitisFn @DrTiffTaft 18/ 🔑SUMMARY
#PreventiveHealth in #IBDPartner
📌MultiD approach to adults & peds pts
📌Cancer Screen (colon, cervical, skin)
📌Screen for osteoporosis
📌Screen for mental health
📌Monitor nutrition
📌Counsel for 🚬 cessation
📌Monitor Tx specific 💉💊 labs

#MondayNightIBD

@MondayNightIBD @DCharabaty @JanssenUS @pfizer @TakedaPharma @CrohnsColitisFn @DrTiffTaft 19/ Great job flexing 💪 that 🧠!

Thanks from @MondayNightIBD @DCharabaty & @BonumCe 4 participating in this Tweetorial!

Get the 🏆 you deserve
🆓 #CME 👉 bit.ly/3qH1DX4

Before you 🏃🏽‍♀️, answer the post-test ❓s 👇
#MondayNightIBD

@MondayNightIBD @DCharabaty @JanssenUS @pfizer @TakedaPharma @CrohnsColitisFn @DrTiffTaft @BonumCe 20/#PostConvo #IBDPoll 1⃣
🆓 #CME 👉 bit.ly/3qH1DX4

28y/oM w #Crohns colitis >⅓ colon
x9yrs in clin & endo remission,IFX x5yrs
Presents for f/up
FCP 75. H/H nml. No FH of colon CA
Last CLN 1y ago: endo + histo remission

🗓️When do you rec timing of his colonoscopies?

@MondayNightIBD @DCharabaty @JanssenUS @pfizer @TakedaPharma @CrohnsColitisFn @DrTiffTaft @BonumCe 21/ 🚨#PostConvo #IBDPoll 2⃣

#MondayNightIBD​
🏆🆓 #CME 👉 bit.ly/3qH1DX4

Which of the following requires ECG prior to tx?

@MondayNightIBD @DCharabaty @JanssenUS @pfizer @TakedaPharma @CrohnsColitisFn @DrTiffTaft @BonumCe 22/ ☕️ More fun w friends 💛

🎥Brunch w @shannonchangmd ☀️ @DCharabaty
🗓️Monday, January 24 🤩

🔦 #CancerScreening in #IBD
🔦 Make or break 🦴 health guidance
🔦🚬 Cessation in #Crohns
➕ more ➕

#MNIBDWebinar
💫 #TMYK

@MondayNightIBD @DCharabaty @JanssenUS @pfizer @TakedaPharma @CrohnsColitisFn @DrTiffTaft @BonumCe 23/ ⏱️ ICYMI #Vaccines & #COVIDvax 💉 in #IBD

👇#MNIBDTweetorial 🧵 w @DrsMeena & @DCharabaty

🔗🔗🔗🔗🔗🔗🔗🔗🔗🔗🔗🔗🔗🔗

https://twitter.com/MondayNightIBD/status/1483569084146995201