American Board of Internal Medicine (ABIM) Certification 2025 – 400 Free Practice Questions to Pass the Exam

The initial general treatment approach for Crohn's disease typically involves starting with thiopurine therapy, specifically azathioprine or 6-mercaptopurine. This is because thiopurines are immunosuppressants that can help induce and maintain remission in patients with moderate to severe Crohn's disease.

The use of thiopurines in the treatment plan aligns with the concept of using a step-up approach to therapy. This method emphasizes beginning with less aggressive treatments before moving to more intensive therapies if needed. Thiopurines are often chosen for their favorable long-term safety profile and effectiveness in managing Crohn's disease.

While anti-TNF agents are important in treating Crohn's patients, especially those who do not respond to conventional therapy, they are generally reserved for cases where more immediate intervention is warranted or when first-line therapies are ineffective. Surgery is also not indicated as an initial approach without prior attempts at medical management unless there are complications that necessitate it.

Thus, the rationale for starting with thiopurines recognizes the importance of managing the disease medically before considering surgical options or more aggressive biologic treatments.