Treatment of extraintestinal manifestations in inflammatory bowel disease.
Inflammatory bowel disease (IBD) is a systemic disease associated with a large number of extraintestinal manifestations (EIM). EIM are present in 15-20% of patients with ulcerative colitis and in 20-40% of patients with Crohn's disease. The management of EIM is best provided by a multidisciplinary team, which includes specialists in the affected organ systems with training in the treatment of IBD. Therapeutic strategy is often empirical. This is explained by the paucity of randomized-controlled studies for the specific treatment of EIM in IBD and by the fact that treatment models are based on extrapolation from patients with similar conditions but without IBD. For most EIM, the mainstay of therapy is the treatment of the underlying active IBD. However, some EIM such as axial arthritis, pyoderma gangrenosum, uveitis and primary sclerosing cholangitis run a clinical course independent of IBD activity and need specific therapy (e.g. TNF antagonists in ankylosing spondylitis and skin manifestations). This review summarizes the conventional and novel (e.g. anti-TNF) treatment modalities, and the therapeutic implications for the management of extraintestinal symptoms in IBD, in order to assist clinicians in optimizing treatment strategies for IBD patients with EIM.
1st Department of Medicine, Semmelweis University, Budapest, Hungary. lakatos.peter_laszlo @ med.semmelweis-univ.hu
Peter L
PL
Lakatos
Laszlo
L
Lakatos
Lajos S
LS
Kiss
Laurent
L
Peyrin-Biroulet
Alain
A
Schoepfer
Stephan
S
Vavricka
D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000925:Anticoagulants / Q000627:therapeutic use; D001168:Arthritis / Q000188:drug therapy* / Q000209:etiology; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D002756:Cholagogues and Choleretics / Q000627:therapeutic use; D015209:Cholangitis, Sclerosing / Q000188:drug therapy* / Q000209:etiology; D005128:Eye Diseases / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D015212:Inflammatory Bowel Diseases / Q000150:complications* / Q000188:drug therapy; D010024:Osteoporosis / Q000188:drug therapy* / Q000209:etiology; D012871:Skin Diseases / Q000188:drug therapy* / Q000209:etiology; D014580:Ursodeoxycholic Acid / Q000627:therapeutic use; D054556:Venous Thromboembolism / Q000188:drug therapy* / Q000209:etiology / Q000517:prevention & control
D000893:Anti-Inflammatory Agents; D000925:Anticoagulants; D050071:Bone Density Conservation Agents; D002756:Cholagogues and Choleretics; D007166:Immunosuppressive Agents; D014580:Ursodeoxycholic Acid