Ustekinumab in patients with Crohn’s disease with extraintestinal manifestations (psoriasis)

Abstract

Ulcerative colitis and Crohn’s disease are severe immune-mediated diseases. Extraintestinal manifestations of inflammatory bowel disease (IBD) significantly increase the burden to the patient. The most common extraintestinal manifestations include erythema nodosum, ankylosing spondylitis, and primary sclerosing cholangitis. Some of the extraintestinal manifestations depend on the activity of the inflammatory process in the intestine and can be reversed during treatment of IBD, while the others require specific therapy, since it does not depend on the degree of inflammation in the intestine. Patients with IBD are at increased risk of developing complications caused by other organ systems, such as osteoporosis, venous thromboembolism, and cardiovascular diseases. Immunemediated diseases such as multiple sclerosis and psoriasis have been associated with inflammatory bowel disease, but these conditions can also be complications of IBD therapy. In this regard, patients and healthcare providers should exercise vigilance in identifying extraintestinal manifestations and complications of IBD, and the therapy should be aimed both at treating the underlying disease and reversing extraintestinal manifestations as much as possible. Interleukin-12/23 is an important cytokine in the inflammatory process development in the immune-mediated diseases. Ustekinumab is effective in treating not only IBD, but also psoriasis by blocking interleukin 12/23. The drug shows a higher survival index of the therapy as compared to tumour necrosis factor-α inhibitors. The article describes the experience of using ustekinumab in severe concomitant pathology – Crohn’s disease in the form of ileocolitis and psoriasis vulgaris with initial manifestations of psoriatic arthritis against ineffectiveness of tumour necrosis factor-α inhibitors.