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Treatment of the extraintestinal manifestations of inflammatory bowel disease

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Abstract

There is a paucity of randomized, controlled therapy studies of the extraintestinal manifestations of inflammatory bowel disease (IBD). Most current therapeutic approaches are empiric or based on approaches to therapy in other settings. In the past year anecdotal evidence has emerged for the use of therapies that neutralize tumor necrosis factor-α in both ankylosing spondylitis and the dermatologic extraintestinal manifestations. Topical tacrolimus has also emerged as a potentially useful therapy for dermatologic manifestations. Finally, patients with IBD occasionally become transplant recipients. One study reported worsening IBD after orthotopic liver transplantation for primary sclerosing cholangitis, and another reported the benefit of renal transplantation in amyloidosis-induced renal failure.

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References and Recommended Reading Papers of particular interest, published recently, have been highlighted as: Of importance Of major importance

  1. Koutkia P, Lu Z, Chen TC, Holick MF: Treatment of vitamin D deficiency due to Crohn’s disease with tanning bed ultraviolet B radiation. Gastroenterology 2001, 121:1485–1488.

    Article  PubMed  CAS  Google Scholar 

  2. Bernstein CN: Risk factors and prevalence of bone disease in inflammatory bowel disease. In Trends in Inflammatory Bowel Disease Therapy. Edited by Williams CN, Bursey RF, Gall DG, et al. Dordrecht: Kluwer Academic Publishers; 1999:147–162.

    Google Scholar 

  3. Holick MF: Sunlight "D"ilemma: risk of skin cancer or bone disease and muscle weakness. Lancet 2001, 357:401–506.

    Article  Google Scholar 

  4. Bernstein CN, Blanchard JF, Rawsthorne P, Yu N: The prevalence of extraintestinal diseases in inflammatory bowel disease: a population-based study. Am J Gastroenterol 2001, 96:1116–1122. This is the first North American population-based study of extraintestinal manifestations in IBD.

    Article  PubMed  CAS  Google Scholar 

  5. Grom AA, Murray KJ, Luyrink L, et al.: Patterns of expression of tumor necrosis factor alpha, bdtumor necrosis factor beta, and their receptors in synovia of patients with juvenile rheumatoid arthritis and juvenile spondyloarthropathy. Arthritis Rheum 1996, 39:1703–1710.

    Article  PubMed  CAS  Google Scholar 

  6. Braun J, Bellow M, Neure L, et al.: Use of immunohistologic and in situ hybridization techniques in the examination of sacroiliac joint biopsy specimens from patients with ankylosing spondylitis. Arthritis Rheum 1995, 38:499–505.

    Article  PubMed  CAS  Google Scholar 

  7. Gorman JD, Sack KE, Davis JC Jr: Treatment of ankylosing spondylitis by inhibition of tumor necrosis factor. N Engl J Med 2002, 346:1349–1356. This important randomized, controlled study proves the value of modulating TNF-’a in ankylosing spondylitis.

    Article  PubMed  CAS  Google Scholar 

  8. Sandborn WJ, Hanauer SB, Katz S, et al.: Etanercept for active Crohn’s disease: a randomized, double-blind, placebocontrolled trial. Gastroenterology 2001, 122:1088–1094.

    Article  Google Scholar 

  9. Targan SR, Hanauer SB, van Deventer SJ, et al.: A short-term study of chimeric monoclonal antibody cA2 to tumor necrosis factor alpha for Crohn’s disease. Crohn’s Disease cA2 Study Group. N Engl J Med 1997, 337:1029–1035.

    Article  PubMed  CAS  Google Scholar 

  10. Brandt J, Haibel H, Cornely D, et al.: Successful treatment of active ankylosing spondylitis with anti-tumor necrosis factor-alpha monoclonal antibody infliximab. Arthritis Rheum 2000, 43:1346–1352.

    Article  PubMed  CAS  Google Scholar 

  11. Stone M, Salonen D, Lax M, et al.: Clinical and imaging correlates of response to treatment with infliximab in patients with ankylosing spondylitis. J Rheumatol 2001, 28:1605–1614.

    PubMed  CAS  Google Scholar 

  12. Michel G, Kemeny L, Homey B, Ruzicka T: FK506 in the treatment of inflammatory skin disease: promises and perspectives. Immunol Today 1996, 17:106–108.

    Article  PubMed  CAS  Google Scholar 

  13. Ruzicka T, Bieber T, Schopf E, et al.: A short term trial of tacrolimus ointment for atopic dermatitis. European Tacrolimus Multicenter Atopic Dermatitis Study Group. N Engl J Med 1997, 337:816–821.

    Article  PubMed  CAS  Google Scholar 

  14. Lauerma AI, Surber C, Maibach HI: Absorption of topical tacrolimus (FK506) in vitro through human skin: comparison with cyclosporin A. Skin Pharmacol 1997, 10:230–234.

    Article  PubMed  CAS  Google Scholar 

  15. Schuppe H-C, Homey B, Assman T, et al.: Topical tacrolimus for pyoderma gangrenosum. Lancet 1998, 351:832.

    Article  PubMed  CAS  Google Scholar 

  16. Casson DH, Eltumi M, Tomlin S, et al.: Topical tacrolimus may be effective in the treatment of oral and perineal Crohn’s disease. Gut 2000, 47:436–440. This study offers an important reminder to gastroenterologists about the use of topical tacrolimus for dermatologic manifestations of IBD.

    Article  PubMed  CAS  Google Scholar 

  17. Huish SB, de la Paz EM, Ellis PR III, Stern PJ: Pyoderma gangrenosum of the hand: a case series and review of the literature. J Hand Surg 2001, 26A:679–685.

    Google Scholar 

  18. Brown RE, Lay L, Graham D: Bilateral pyoderma gangrenosum of the hand: treatment with dapsone. J Hand Surg 1993, 18B:119–121.

    Google Scholar 

  19. Tan M-H, Gordon M, Lebwohl O, et al.: Improvement in pyoderma gangrenosum and psoriasis associated with Crohn disease with anti-tumor necrosis factor a monoclonal antibody. Arch Dermatol 2001, 137:930–33.

    PubMed  CAS  Google Scholar 

  20. Reguerio M, Plevy S, Valentine J, et al.: Successful treatment of IBD-associated pyoderma gangrenosum with infliximab [abstract]. Gastroenterology 2002, 122:A616.

    Google Scholar 

  21. Foster E, Nguyen KK, Bolce R, Prindiville TP: Cutaneous manifestations of inflammatory bowel disease improve with infliximab therapy [abstract]. Gastroenterology 2002, 122:A618.

    Google Scholar 

  22. Tung BY, Emond MJ, Haggitt RC, et al.: Ursodiol use is associated with lower prevalence of colonic neoplasia in patients with ulcerative colitis and primary sclerosing cholangitis. Ann Intern Med 2001, 134:89–95.

    PubMed  CAS  Google Scholar 

  23. Dvorchik I, Subotin M, Demetris AJ, et al.: Effect of liver transplantation on inflammatory bowel disease in patients with primary sclerosing cholangitis. Hepatology 2002, 35:380–384.

    Article  PubMed  Google Scholar 

  24. Ben-Ami H, Ginesin Y, Behar DM, et al.: Diagnosis and treatment of urinary tract complications in Crohn’s disease: an experience over 15 years. Can J Gastroenterol 2002, 16:225–229.

    PubMed  Google Scholar 

  25. Pardi DS, Tremaine WJ, Sandborn WJ, et al.: Renal and urologic complications of inflammatory bowel disease. Am J Gastroenterol 1998, 93:505–514.

    Google Scholar 

  26. Wester AL, Vatn MH, Fausa O: Secondary amyloidosis in inflammatory bowel disease: a study of 18 patients admitted to Rikshospitalet University Hospital, Oslo, from 1962 to 1998. Inflamm Bowel Dis 2001, 7:295–300.

    Article  PubMed  CAS  Google Scholar 

  27. Nash CL, Pannacione R, Sutherland LR, Meddings JB: Giant cell myocarditis in a patient with Crohn’s disease, treated with etanercept—a tumor necrosis factor-alpha antagonist. Can J Gastroenterol 2001, 15:607–611.

    PubMed  CAS  Google Scholar 

  28. Deswal A, Bozkurr B, Seta Y, et al.: Safety and efficacy of a soluble p75 tumor necrosis factor receptor (Enbrel, etanercept) in patients with advanced heart failure. Circulation 1999, 99:3224–3226.

    PubMed  CAS  Google Scholar 

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Bernstein, C.N. Treatment of the extraintestinal manifestations of inflammatory bowel disease. Curr Gastroenterol Rep 4, 513–516 (2002). https://doi.org/10.1007/s11894-002-0028-9

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