Extraintestinal manifestations in inflammatory bowel disease

Table 1 Major extraintestinal immune-related manifestations of IBD

Arthritis

Erythema nodosum

Pyoderma gangrenosum

Aphthous stomatitis

Iritis/uveitis

Table 2 Autoimmune disorders associated to IBD

Alopecia areata

Ankylosing spondylitis

Bronchiolitis obliterans

Cold urticaria

Hemolytic anemia

Henoch-Schoenlein purpura

Insulin-dependent diabetes mellitus

Pancreatitis

Primary biliary cirrhosis

Primary sclerosing cholangitis

Polymyositis

Raynaud phenomenon

Seropositive rheumatoid arthritis

Sjogren syndrome

Thyroid disease

Vitiligo

Wegener’s granulomatosis

Takayasu’s arteritis

Table 3 Extraintestinal complications in IBD and principal pathogenetic mechanisms of arthritis

Extraintestinal
complications in IBD	Principal pathogenetic mechanisms of arthritis
Anemia	Iron deficiency, inflammation
Thromboembolic events	Hypercoagulopathies, platelet activation
Osteopathy	Steroid therapy, vitamin D deficiency inflammation
Growth failure	Malnutrition
Nephrolithiasis	Dehydration, hyperoxaluria, low urinary PH
Cholelithiasis	Intestinal loss of bile acids
Amyloidosis	Acute phase reaction, chronic inflammation
Fatty liver	Malnutrition

Table 4 Drugs and their possible adverse side effects

Drugs	Possible adverse side effects
Corticosteroids	Acne, fluid retention, fat redistribution, hypertension, hyperglycemia, psycho-neurological disturbances, cataracts, growth failure in children, osteonecrosis[115]
Mesalazine	Nausea, dyspepsia, rare nephritis, rare idiosyncratic worsening of IBD[116]
Sulfapyridine	Headache, nausea, anorexia, rare hypersensibility hepatitis, hemolytic anemia, pancreatitis, reversible sperm abnormalities, worsening of IBD[116]
Azathioprine/mercaptopurine	Pancreatitis, bone marrow suppression, hepatotoxicity[115]
Methotrexate	Nausea, leucopenia, hepatic fibrosis, hypersensibility pneumonia[117]
Cyclosporin	Nephrotoxicity, hypertension, headache, gingival hyperplasia, paresthesias[115]
Tacrolimus	Nephrotoxicity[115]
Infliximab	Infusion reactions, delayed hypersensitivity-like reactions, drug-induced lupus, tuberculosis reactivation[118]
Metronidazole	Nausea, metallic taste, peripheral neuropathy[115]