From the Guidelines
Extraintestinal manifestations (EIMs) in inflammatory bowel disease (IBD) should be managed with a multidisciplinary approach, focusing on controlling the underlying IBD and addressing specific EIMs, as recommended by the most recent guidelines 1. The management of EIMs in IBD is crucial to improve patient outcomes, as these manifestations can significantly impact morbidity, mortality, and quality of life. Some EIMs, such as arthritis, erythema nodosum, and pyoderma gangrenosum, may parallel intestinal disease activity and improve with IBD treatment, while others, like primary sclerosing cholangitis, may run an independent course requiring specific management 1. Anaemia is a common EIM in IBD, and its management is critical, with intravenous iron recommended as first-line treatment in patients with clinically active IBD, previous intolerance to oral iron, or hemoglobin below 100 g/L 1. The presence of EIMs, including arthritis, should be assessed in all IBD patients, and treatment should be tailored to the individual patient's needs, with a focus on improving quality of life and reducing morbidity and mortality 1. In patients with IBD-associated spondyloarthritis, treatment options, including biologics and JAK inhibitors, should be considered, and the decision to treat should be made on a case-by-case basis, taking into account the patient's disease activity, medical history, and potential side effects 1. Key considerations in the management of EIMs in IBD include:
- Early recognition and diagnosis of EIMs
- Multidisciplinary care involving gastroenterologists, rheumatologists, dermatologists, and ophthalmologists
- Tailored treatment approaches addressing both the underlying IBD and specific EIMs
- Regular monitoring and assessment of disease activity and treatment response
- Patient education and support to improve quality of life and adherence to treatment plans.
From the Research
Extraintestinal Manifestations in IBD
- Extraintestinal manifestations (EIMs) in inflammatory bowel disease (IBD) are frequent and can significantly affect morbidity and mortality, with a prevalence ranging from 6 to 47% 2.
- EIMs can occur in up to 24% of patients with IBD before the onset of intestinal symptoms, and need to be recognized to initiate appropriate diagnostic procedures 3.
- The most commonly affected organs are joints, skin, or eyes, but EIMs can also affect other organs, such as the liver, lung, and pancreas 3, 4.
Skin Manifestations
- Skin lesions are usually classified into four categories: specific, reactive, associated, and treatment-induced manifestations 2.
- Cutaneous manifestations include erythema nodosum (EN), pyoderma gangrenosum (PG), Sweet's syndrome, and oral lesions, with EN being the most commonly reported and PG showing the most debilitating disease course 2.
- Dermatological manifestations associated with IBDs include specific manifestations, cutaneous disorders associated with IBDs, reactive mucocutaneous manifestations, mucocutaneous conditions secondary to treatment, and manifestations due to nutritional malabsorption 5.
Pathophysiology and Treatment
- The pathophysiology of EIMs remains elusive, although data from clinical trials demonstrating anti-tumor necrosis factor (TNF) efficacy suggest a common pathogenic link between intestinal and extraintestinal disease activity 2.
- Medical treatment modalities are limited, with topical and systemic steroids being the most frequently employed agents 2.
- Successful therapy of EIM is essential for improving quality of life of patients with IBD, and tumor necrosis factor antibody therapy is an important therapy for EIM in patients with IBD 4.
- An accurate dermatological examination is essential in all IBD patients, especially in candidates to biologic therapies, in whom drug-induced cutaneous reactions may assume marked clinical relevance 5.