American Board of Internal Medicine (ABIM) Certification Practice Exam

What should be initiated for patients who require repeated courses of glucocorticoids for ulcerative colitis?

1. 5-aminosalicylate agents

2. Thiopurines or anti-TNF agents

3. Proton Pump Inhibitors

4. Antibiotics

The correct answer is: Thiopurines or anti-TNF agents

In managing patients with ulcerative colitis who require repeated courses of glucocorticoids, it is crucial to consider long-term management strategies to minimize the potential complications associated with chronic steroid use. Glucocorticoids can provide short-term relief from symptoms, but they do not modify the underlying disease course and can lead to significant side effects with prolonged use, such as osteoporosis, increased infection risk, and adrenal suppression. Initiating thiopurines (such as azathioprine or mercaptopurine) or anti-TNF agents (like infliximab or adalimumab) is a strategy aimed at achieving disease control through immunosuppression and maintenance therapy. Thiopurines serve as immunomodulatory agents that help reduce the frequency of flares, allowing patients to taper off glucocorticoids more safely. Anti-TNF agents, on the other hand, are biologics that inhibit tumor necrosis factor-alpha, which plays a significant role in inflammation in ulcerative colitis. Both thiopurines and anti-TNF agents can help induce remission and maintain long-term disease control, ultimately reducing the need for repeated glucocorticoid courses. This approach improves the patient's quality of life and minimizes the risks