Systemic medical management of peripheral and axial arthritis in patients with inflammatory bowel disease*^¶Δ

IBD: inflammatory bowel disease; GI: gastrointestinal; NSAID: nonsteroidal antiinflammatory drug; mab: monoclonal antibody; TNF: tumor necrosis factor; IL: interleukin.
* Refer to UpToDate topic on treatment of arthritis associated with inflammatory bowel disease.
¶ Patients should be treated in collaboration with the patient's gastroenterologist.
Δ Intraarticular glucocorticoid injection is a potential added treatment option in a patient with a small number of affected joints.
◊ Refer to UpToDate topics on the management of ulcerative colitis and Crohn disease in adults.
§ Patients with axial disease should receive physical therapy for back exercise program.
¥ Refer to UpToDate topic on treatment of arthritis associated with inflammatory bowel disease for drug and dosing regimens.
‡ NSAIDs should not be administered for peripheral arthritis without excluding septic arthritis as the cause of joint inflammation (refer to UpToDate topic on septic arthritis in adults).
† Symptoms and signs of peripheral arthritis and inflammatory back pain and stiffness are well controlled.