Positioning and sequencing of advanced therapies in inflammatory bowel disease: A guide for clinical practice

Table 5 Summary of common extraintestinal manifestations, their association with intestinal activity, and recommended therapies

Extraintestinal manifestation	Association with intestinal activity	Therapies
Peripheral arthritis (type 1)	Associated	Anti-TNF agents, vedolizumab, anti-IL agents, JAK inhibitors
Peripheral arthritis (type 2)	Independent	NSAIDs (with caution), methotrexate, anti-TNF agents, JAK inhibitors
Axial spondyloarthritis	Independent	Anti-TNF agents, JAK inhibitors
Uveitis	Independent	Anti-TNF agents, topical or systemic corticosteroids
Episcleritis	Associated	IBD therapy, topical corticosteroids
Pyoderma gangrenosum	Independent or associated	1st line option: Anti-TNF agents, systemic corticosteroids; 2nd line option: Cyclosporine; 3rd line option: JAK inhibitors, anti-IL agents
Erythema nodosum	Associated	IBD therapy, systemic corticosteroids
Psoriasis and psoriatic arthritis	Independent	1st line option: Anti-IL agents; 2nd line option: Anti-TNF agents; 3rd line option: JAK inhibitors
Primary sclerosing cholangitis	Independent	Treatment is independent of IBD treatment; Ursodeoxycholic acid, liver transplantation in severe cases
Osteoporosis	Independent	Treatment is independent of IBD treatment; Calcium, vitamin D, bisphosphonates
Venous thromboembolism	Associated	Treatment is independent of IBD treatment; Anticoagulation therapy
Autoimmune hemolytic anemia	Associated	Systemic corticosteroids, immunosuppressants

IL: Interleukin; TNF: Tumoral necrosis factor; JAK: Janus kinase; IBD: Inflammatory bowel disease; NSAIDs: Non-steroidal anti-inflammatory drugs.