Joseph Sleiman, MD

Follow @JosephHabibi_MD

May 16 • 8 tweets • 43 min read

@MondayNightIBD @BassiMehak @abbvie @JanssenUS @ferring @TakedaPharma #PreConvo #IBDPoll1⃣

🆓#CME bit.ly/3wdwE7J

25y/oM w refractory #UlcerativeColitis undergo colectomy w IPAA. Takes acetaminophen PRN headaches & drinks a🍷glass w dinner. Presents for a routine f/up visit. labs: Alk Phos 250. What is the most likely cause of this AP?

@MondayNightIBD @BassiMehak @abbvie @JanssenUS @ferring @TakedaPharma #PreConvo #IBDPoll2⃣

🆓#CME bit.ly/3wdwE7J

What is the most common extra-intestinal manifestation #EIM in patients living with #IBD?

@MondayNightIBD @BassiMehak @abbvie @JanssenUS @ferring @TakedaPharma 1/⬆️ EIMs in #IBD
⭐️ CD > UC.
⭐️ Colon involvement

💣 Pathol:
⭐️ Direct result of bowel disease (e.g kidney stone from oxalate malabsorption )
⭐️ Influx of mononuclear cells activated in the intestine➡️another organ
⭐️ Systemic Immune activation independent of gut🔥

@MondayNightIBD @BassiMehak @abbvie @JanssenUS @ferring @TakedaPharma @GI_Pearls @ARodriguezDO @dishasharma1994 @noorannemd @galagodoyb @KrystalMillsMD @yaransarkis @MazenAlmasry4 @MaryamK_Ibrahim @JBapaye 2/ EIM come in different shapes & forms

🔺Can precede GI symptoms
🔺Can manifest with gut 🔥 and resolve with gut 🔥 control
🔺Can be independent of gut 🔥 , or occur after colectomy in UC

@MondayNightIBD @BassiMehak @abbvie @JanssenUS @ferring @TakedaPharma @GI_Pearls @ARodriguezDO @dishasharma1994 @noorannemd @galagodoyb @KrystalMillsMD @yaransarkis @MazenAlmasry4 @MaryamK_Ibrahim @JBapaye @priya_abhy @CatherineWangMD @CCYANetwork @DushDahiya @Apichatka @SanjeevaniTomar @FnuVikash @EHolzwanger @RazzakFarah @ShimaghavimiMD 3/ #Joint: Most common EIM

🦴25% have peripheral arthralgias

🦴Knee, ankle affected first ▶️ to upper joints.

🦴Fewer arthritic complications in pts w ileocecal resection.

🦴Axial arthritis:
10% have Sacroiliitis (often asymptomatic)
3% have ankylosing spondylitis

@MondayNightIBD @BassiMehak @abbvie @JanssenUS @ferring @TakedaPharma @GI_Pearls @ARodriguezDO @dishasharma1994 @noorannemd @galagodoyb @KrystalMillsMD @yaransarkis @MazenAlmasry4 @MaryamK_Ibrahim @JBapaye @priya_abhy @CatherineWangMD @CCYANetwork @DushDahiya @Apichatka @SanjeevaniTomar @FnuVikash @EHolzwanger @RazzakFarah @ShimaghavimiMD @ZarrarKhanMD @Timothy_A_Zaki @mahirxqureshi @JassimranSingh9 @NickLe64 @TrieuMD @MahamHayatMD @ASyedMD @SheharyarW @DrFiyin 4/ #Skin EIMs

🔸5-15% of pts
🔸Most common:
🔺Erythema nodosum: often on shin, resolve w Rx of gut 🔥
🔺Pyoderma gangrenosum: on LE, trauma/Sx area, avoid Bx, respond to TNFi
🔸Hidradenitis suppurativa: 🚫confuse w perianal dis
🔸Rare: Sweet Syndrome, Metastatic Crohn's dis

@MondayNightIBD @BassiMehak @abbvie @JanssenUS @ferring @TakedaPharma @GI_Pearls @ARodriguezDO @dishasharma1994 @noorannemd @galagodoyb @KrystalMillsMD @yaransarkis @MazenAlmasry4 @MaryamK_Ibrahim @JBapaye @priya_abhy @CatherineWangMD @CCYANetwork @DushDahiya @Apichatka @SanjeevaniTomar @FnuVikash @EHolzwanger @RazzakFarah @ShimaghavimiMD @ZarrarKhanMD @Timothy_A_Zaki @mahirxqureshi @JassimranSingh9 @NickLe64 @TrieuMD @MahamHayatMD @ASyedMD @SheharyarW @DrFiyin @aileenbui @Wissam_Ghusn @AdvaniRashmiMD @DVinsard @WilechanskyMD @NSeth2021 @nelson1987 @ReezwanaCMD @AimenKhanMD @DrewfordMD 5/ #PSC

🎯80% of PSC have IBD
🎯5% of UC

⬆️ALP/GGT should trigger eval w MRCP
‼️Can be dx before or after dx of IBD, or even after colectomy in UC
‼️ Assoc. w ⬆️ risk of colon CA, GB CA, cirrhosis, cholangioCA

🎯Median survival time w/o liver transplantation is 10 years.

@MondayNightIBD @BassiMehak @abbvie @JanssenUS @ferring @TakedaPharma @GI_Pearls @ARodriguezDO @dishasharma1994 @noorannemd @galagodoyb @KrystalMillsMD @yaransarkis @MazenAlmasry4 @MaryamK_Ibrahim @JBapaye @priya_abhy @CatherineWangMD @CCYANetwork @DushDahiya @Apichatka @SanjeevaniTomar @FnuVikash @EHolzwanger @RazzakFarah @ShimaghavimiMD @ZarrarKhanMD @Timothy_A_Zaki @mahirxqureshi @JassimranSingh9 @NickLe64 @TrieuMD @MahamHayatMD @ASyedMD @SheharyarW @DrFiyin @aileenbui @Wissam_Ghusn @AdvaniRashmiMD @DVinsard @WilechanskyMD @NSeth2021 @nelson1987 @ReezwanaCMD @AimenKhanMD @DrewfordMD 6/ 👀EIMs

🔸3rd most common EIM (2-7%), 🧒>👨, CD>UC
🔸Most common: Episcleritis•scleritis•anterior uveitis (medical emergency!)•
🔸Rare: retinal vasculitis•papillitis•corneal infiltrates•myositis•scleromalacia perforans•optic neuritis
🔸co-occur w/ Skin & Joint EIMs

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Joseph Sleiman, MD

@JosephHabibi_MD

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https://twitter.com/squeenbryant/status/1244522141804040194

If you have 12 minutes to spare, enjoy this well illustrated thesis on the topic, it might change your mind. @medpedshosp

https://twitter.com/medpedshosp/status/1244626739751538689

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@JosephHabibi_MD

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