Ulcerative Colitis Clinical Case Review

Sujaata Dwadasi, MD, an IBD Specialist at Carle Foundation Hospital in Illinois, discusses the treatment options available to the patient in this case:

“When choosing a therapy option for IBD patients, and in particular, ulcerative colitis patients, we always want to think about a few factors.

One is thinking about the location and severity of the disease. Is the patient having inflammation just in their rectum and sigmoid? Is it left-sided colitis or pancolitis? And of course, the severity: mild, moderate or severe. Also, thinking about patient characteristics — their age, other comorbidities — and social factors. Would they have any issues getting to infusions? Would they be amenable to giving themselves injections? If they’re a female, are they planning on getting pregnant anytime soon? These types of social factors.

Of course, also discussing different symptoms, including extraintestinal manifestations. Taking into account all these different factors, along with talking with the patient, you can make a patient-centered decision, and that will also help the patient feel more comfortable with the new therapy.

As far as therapy options for UC in a patient who you suspect has IBD arthropathy as well, you want to make sure that we’re treating the luminal inflammation. If it’s a therapy such as sulfasalazine, it would not be a great therapy for moderate to severe inflammation; it would be only for mild inflammation of the luminal disease. If they have moderate to severe disease, you would think about a biologic, and the sulfasalazine could be a concomitant therapy.

And the same thing with methotrexate: Methotrexate is not a therapy for UC; it would be a concomitant therapy along with a biologic.

Anti-TNF therapies can treat both their luminal inflammation as well as IBD arthropathy. Other therapies, such as anti-interleukin 23 and JAK inhibitors, [which] have rheumatologic indications [for] psoriatic arthritis and rheumatoid arthritis. We do not have a lot of data just yet saying that these are actual therapies for IBD arthropathy, but there could potentially be an overlap and something to consider.”