Jamie Brogan, APRN, on Extraintestinal Manifestations of IBD
Jamie Brogan, APRN, reviews her presentation on identifying and treating the most frequently seen extraintestinal manifestations among patients with inflammatory bowel disease.
Jamie Brogan, APRN, is a nurse practitioner specializing in the care of patients with IBD at Northwestern Medicine in Chicago, Illinois.
Transcript:
Hello. My name is Jamie Brogan. I'm a nurse practitioner. I work with inflammatory bowel disease patients at Northwestern, and I'm here at the AIBD regionals in Chicago. I presented on extraintestinal manifestations in inflammatory bowel disease.
Primarily when we see patients with extraintestinal manifestations of IBD, we always want to make sure we're looking for active uncontrolled inflammatory bowel disease or luminal inflammation. In this presentation, we focused on 3 main subsections of rheumatologic, primarily focusing on arthropathies. We focused on some dermatologics and also some ocular.
For the arthropathies, which are the most commonly noted in patients with inflammatory bowel disease, we see axial, peripheral, and sometimes a combination of the 2. While we like to engage our rheumatologic colleagues in managing these patients, we always want to make sure we can at least get the ball rolling for them. We identified that some are more related to underlying active inflammatory bowel disease and to make sure that we're utilizing our treatments to best control that inflammation in order to potentially improve their arthropathies.
For our dermatologic manifestations, we focused primarily on erythema nodosum, pyoderma gangrenosum, and we also talked about Sweet syndrome, which is more predominantly associated with patients with Crohn's disease. For all of these manifestations, we do want to take a look at underlying inflammation in the gut, but we don't see a strong correlation in our patients with pyoderma gangrenosum. For these patients, we want to consider local as well as systemic therapy, local therapy, considering dermatologic interventions such as injections or topical steroids. In some more severe cases, systemic steroids may be indicated, and of course, optimizing their IBD therapy.
For ocular manifestations, we looked at episcleritis, which is manifested with pain, redness to the eye, and can sometimes even just be treated with some saline drops. For scleritis, we see more significant pain. There is a correlation with underlying IVD and we would probably want to treat with some topical steroids and potentially systemic.
For uveitis, the third ocular manifestation we talked about, there is a strong correlation with Crohn's disease, and those patients not only need topical steroid treatment, but sometimes systemic steroid treatment, and we will usually utilize TNF therapy in the management of these patients.
The overarching theme for all of these is to remember that these extraintestinal manifestations do exist in sometimes almost 50% of patients with inflammatory bowel disease, so understanding that they can be related to underlying IBD, to optimize your IBD therapy and to make sure you've generated a good network of rheumatology, dermatology, and ophthalmology colleagues, in order to best support your patients with IBD.
