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🌱 來自: inflammatory bowel disease

extraintestinal manifestations of inflammatory bowel disease

CATEGORY	CLINICAL COURSE	TREATMENT
Rheumatologic disorders (5–20%)
Peripheral arthritis	Asymmetric, migratory Parallels bowel activity	Reduce bowel inflammation
Sacroiliitis	Symmetric: spine and hip joints Independent of bowel activity	Steroids, injections, methotrexate, anti-TNF
Ankylosing spondylitis	Gradual fusion of spine Independent of bowel activity Two-thirds have HLA-B27 antigen	Physical therapy, steroids, injections, methotrexate, anti-TNF, IL-17 inhibitors, tofacitinib
Metabolic bone disorders (up to 40% of patients)
Osteoporosis	Risk increased by glucocorticoids, cyclosporine, methotrexate, total parenteral nutrition, malabsorption, and inflammation Fracture rates highest in the elderly (age >60)	Screening with DEXA scan, check vitamin D levels, treat if osteoporosis or osteopenia on long-term corticosteroids
Osteonecrosis	Death of osteocytes and adipocytes and eventual bone collapse; affects hips more than knees or shoulders; risk factor is steroid use	Pain control, injections, joint replacement
Dermatologic disorders (10–20%)
Erythema nodosum	Hot, red, tender, nodules/extremities Parallels bowel activity	Reduce bowel inflammation
Pyoderma gangrenosum	Ulcerating, necrotic lesions on extremities, trunk, face, stoma Independent of bowel activity	Antibiotics, steroids, cyclosporine, infliximab, dapsone, azathioprine, intralesional steroids; not debridement or colectomy
Psoriasis	Unrelated to bowel activity	Topical steroids, light therapy, methotrexate, infliximab, adalimumab, ustekinumab
Pyoderma vegetans	Intertriginous areas Parallels bowel activity	Evanescent; resolves without progression
Pyostomatitis vegetans	Mucous membranes Parallels bowel activity	Evanescent; resolves without progression
Metastatic Crohn’s disease (CD)	CD of the skin Parallels bowel activity	Reduce bowel inflammation
Sweet syndrome	Neutrophilic dermatosis Parallels bowel activity	Reduce bowel inflammation
Aphthous stomatitis	Oral ulcerations Parallels bowel activity	Reduce bowel inflammation/topical therapy
Ocular disorders (1–11%)
Uveitis	Ocular pain, photophobia, blurred vision, headache Independent of bowel activity	Topical or systemic steroids
Episcleritis	Mild ocular burning Parallels bowel activity	Topical corticosteroids
Hepatobiliary disorders (10–35%)
Fatty liver	Secondary to chronic illness, malnutrition, steroid therapy	Improve nutrition, reduce steroids
Cholelithiasis	Patients with ileitis or ileal resection Malabsorption of bile acids, depletion of bile salt pool, secretion of lithogenic bile	Reduce bowel inflammation; cholecystectomy in symptomatic patients
Primary sclerosing cholangitis (PSC)	Intrahepatic and extrahepatic Inflammation and fibrosis leading to biliary cirrhosis and hepatic failure 7–10% cholangiocarcinoma Small-duct PSC involves small-caliber bile ducts and has a better prognosis	ERCP/high-dose ursodiol lowers risk of colonic neoplasia; cholecystectomy in patients with gallbladder polyps due to the high incidence of malignancy
Urologic
Nephrolithiasis (10–20%)	CD patients following small-bowel resection; calcium oxalate stones most common	Low-oxalate diet; control of bowel inflammation; surgical intervention
Less common extraintestinal manifestations
Thromboembolic disorders	Increased risk of venous and arterial thrombosis; factors responsible include abnormalities of the platelet-endothelial interaction, hyperhomocysteinemia, alterations in the coagulation cascade, impaired fibrinolysis, involvement of tissue factor–bearing microvesicles, disruption of the normal coagulation system by autoantibodies, and a genetic predisposition	Anticoagulation; control of inflammation
Cardiopulmonary	Endocarditis, myocarditis, pleuropericarditis, interstitial lung disease	Treatment is varied; stop 5-ASA agents as they can rarely cause interstitial lung disease
Systemic amyloidosis	Secondary (reactive) in long-standing IBD, especially CD	Colchicine
Pancreatitis	Duodenal fistulas, ampullary CD, gallstones, PSC, drugs (MP, azathioprine, 5-ASAs), autoimmune, primary CD of the pancreas	Treatment is varied; stop offending medication; diagnose and treat with ERCP and/or cholecystectomy