© Springer International Publishing AG 2018 49
A.S. Cheifetz, J.D. Feuerstein (eds.), Treatment of Inflammatory
Bowel Disease with Biologics, https://doi.org/10.1007/978-3-319-60276-9_4
Chapter 4
Anti-TNF Therapy for Treatment
of Extraintestinal Manifestations
of Inflammatory Bowel Disease
David I. Fudman and Sarah N. Flier
Extraintestinal manifestations (EIM) of inflammatory bowel disease (IBD) are
common, affecting up to one half of IBD patients [ 1 – 7 ], and are of major clini-
cal 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 sever-
ity from mild to debilitating. Patients may experience one or multiple EIM
simultaneously, and the presence of one EIM increases the likelihood of devel-
oping other EIM [ 3 , 6 ]. In some cases, the EIM may be more severe than the
intestinal disease itself. While some EIM such as erythema nodosum and pau-
ciarticular arthritis typically parallel luminal disease activity, others such as
uveitis and ankylosing spondylitis may be active without concomitant intestinal
disease [ 8 , 9 ]. This pattern and the approach to treatment is further complicated
by the fact that EIM of IBD may develop even before the onset of gastrointesti-
nal symptoms [ 8 ].
Although EIM of IBD can affect nearly every organ system, the use of anti-TNF
therapy has been examined in only a subset of manifestations and is of varying effi-
cacy depending on the condition being studied. Most data regarding the use of anti-
TNFs for EIM of IBD are retrospective and have focused on patients with Crohn’s
disease (CD) rather than ulcerative colitis (UC). Nonetheless, for some extraintesti-
nal conditions, the data for the use of anti-TNF therapy are robust.
Both infliximab and adalimumab can be effective in controlling certain EIM
of IBD as will be reviewed below. Data for the use of certolizumab pegol and
golimumab for EIM are lacking and, as has been the case for luminal disease,
D.I. Fudman • S.N. Flier (*)
Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215, USA
e-mail: [email protected]