1. 소화기내과 R3 이태인 / Prof. 김효종

2.  Includes  Disorders of the musculoskeletal, hepatobiliary, skin, ocular, metabolic, etc.  Prevalence  21~36% of IBD patients  more common in CD than UC

3.  Multiple theories  IMIDs ▪ Common inflammatory pathway, similar immune dysregulation  Epitope spreading  Homing of lymphocytes from the gut mucosa to the other tissue mucosa

5. Parallel disease activityIndependent of disease activity Peripheral arthritis (Large jt>small jt) : 80%PSC Erythema nodosum : over 90%Uveitis Pyoderma gangrenosum (in UC)Axial arthropathy Episcleritis : 78% Inflammatory Bowel Disease;14(S2):S200-201 Gastroenterology 2002;123:714-718 Gut 1998;42:387-391

6.  Peripheral arthropathy  5~20% patients with IBD  CD > UC  Sero-negative (RF negative)  No permanent joint deformity  Usually responds to treatment of colitis  Type 1 (Pauci-articular), Type 2 (Poly-articular) Feldman: Sleisenger & Fordtran’s GI and Liver disease, 8 th Ed

7.  Axial arthropathy  Less common than peripheral (3~5%)  Spondylitis/Sacroilitis : HLA-B27 (+/-)  Low back pain and morning stiffness  Disease does not parallel bowel activity

8.  Treatment  General supportive care, NSAIDs, local steroid injections, and physiotherapy  Underlying IBD manage  Sulfasalazine, MTX, AZA, Anti-TNF therapy ECCO guideline Statement 13B

9.  Osteoporosis/osteopenia  DEXA scanning  Amyloidosis  Pseudoarthritis due to withdrawal of steroids

10.  Primary sclerosing cholangitis  Most common hepatobiliary complication  UC (85~90%) > CD (rare)  MRCP : usual diagnostic test ▪ Irregular bile ducts, bearing zones of both narrowing and dilatation Hepatology 2004;40:39-45 5%IBD 80% PSC

11.  PSC-IBD  Distinct pattern of clinical findings in IBD with PSC ▪ more rectal sparing, backwash ileitis, colorectal cancer  Pericholangitis, steatosis, cirrhosis, pancreatitis, gallstone formation, etc. Gut 2005;54:91-96

13.  Treatment  Respond to Ursodiol ▪ 20mg/kg daily ▪ Improve prognosis, LFT  Tacrolimus  Liver transplantation as needed ECCO guideline 13H

14. Pyoderma Gangrenosum Erythema Nodosum UC > CD (5% vs 2%) Most often on the leg or around a stoma Pathergy Papule, pustule ~ Ulceration CD > UC Extensor surfaces of the extremities Tender, red subcutaneous nodules (1-5cm) Occurs with flares of bowel symptoms

15.  Treatment  PG : initially treated with systemic steroids or calcineurin inhibitors or infliximab  EN : baseline IBD treatment & systemic steroids ECCO guideline Statement 13D, 13E Can J Gastroenterol 2005;19:603-6

16. DiagnosisFindingsVisual activityAssociation with bowel disease EpiscleritisCD>UC Scleral/conjunctival injection NoYes UveitisHeadache, eye pain, photophobia, blurred vision Can lead to blindness if untreated Less predictable Inflamm Bowel Dis 2004;10:135-9

17.  Both UC and CD are prothrombotic  Venous > arterial  Prevalence  1.2~6.7% in clinical studies  US and venography for diagnosis  More relevant and many of the hemostatic alterations Am J Gastroenterol 2008;103:1-9

18.  11337025 박 O 현 (M/51)