Anti-TNF therapy for treatment of extraintestinal manifestations of inflammatory bowel disease

Extraintestinal manifestations (EIM) of inflammatory bowel disease (IBD) are common, affecting up to one half of IBD patients (Vavricka et al., Inflamm Bowel Dis. 21:1794-800, 2015; Bernstein et al., Am J Gastroenterol. 96:1116-22, 2001; Vavricka et al., Am J Gastroenterol. 106:110-9, 2011; Zippi et al., World J Gastroenterol. 20:17463-7, 2014; Isene et al., Scand J Gastroenterol. 50:300-5, 2015; Veloso et al., J Clin Gastroenterol. 23:29-34, 1996; Greenstein et al., Medicine 55:401-12, 1976), and are of major clinical importance because of their impact on the health and quality of life of those affected. EIM of IBD can affect nearly any organ system with a range of severity from mild to debilitating. Patients may experience one or multiple EIM simultaneously, and the presence of one EIM increases the likelihood of developing other EIM (Vavricka et al., Am J Gastroenterol. 106:110-9, 2011; Veloso et al., J Clin Gastroenterol. 23:29-34, 1996). In some cases, the EIM may be more severe than the intestinal disease itself. While some EIM such as erythema nodosum and pauciarticular arthritis typically parallel luminal disease activity, others such as uveitis and ankylosing spondylitis may be active without concomitant intestinal disease (Vavricka et al., Inflamm Bowel Dis. 21:1982-92, 2015; Levine and Burakoff, Gastroenterol Hepatol. 7:235-41, 2011). This pattern and the approach to treatment is further complicated by the fact that EIM of IBD may develop even before the onset of gastrointestinal symptoms (Vavricka et al., Inflamm Bowel Dis. 21:1982-92, 2015).