A case of bowel-associated dermatosis-arthritis syndrome treated with ustekinumab: The importance of targeting underlying gastrointestinal disease

Enthesitis in Bowel-Associated Dermatosis-Arthritis Syndrome in an Ulcerative Colitis Patient

“…This underscores the importance of immune complex-mediated pathophysiology as an important role in bowel-associated dermatosis-arthritis syndrome. It suggests that properly controlling the underlying inflammatory bowel disease will play an important role in the management of IBD [ 7 ]. The American College of Gastroenterology recommended the surveillance colonoscopies in patient with UC at 1–3-year intervals based on the risk factors to develop a colorectal cancer and the significant findings on the previously done colonoscopy [ 8 ].…”

Bowel-associated dermatosis-arthritis syndrome (BADAS): a narrative review

“…With regard to leukocytoclastic vasculitis, there are differing opinions on its occurrence in BADAS. Some deny its presence altogether, while others report that leukocytoclasia may be observed, but without primary vasculitis [ 22 , 26 ]. The literature is consistent on the absence of fibrinoid vascular degeneration in the course of BADAS, although a case has been described where fibrinoid necrosis was demonstrated in the histopathological image [ 9 ].…”

“…It is worth considering the inclusion of biological treatment, especially in the case of disease recurrence or after ineffective antibiotic/steroid therapy, as well as in paediatric patients in whom BADAS could be the first symptom of IBD [ 5 , 6 , 26 , 32 ]. In the treatment of this disease, interleukin-12 and interleukin-23 inhibitors, ustekinumab, have gained prominence in recent years [ 26 , 34 ]. Most reports refer to the use of this drug in the treatment of neutrophilic dermatoses, most often pyoderma gangrenosum associated with Crohn’s disease.…”

“…applied this treatment and reported a complete remission of Crohn’s disease in their patients, of which 4 out of 7 had neutrophilic dermatosis [ 26 ]. They observed an improvement not only in skin lesions, but also in changes of the oral cavity, as well as gastrointestinal symptoms reduction [ 26 , 35 , 36 ]. Recurrences after successful biological treatment are uncommon [ 6 ].…”

“…In turn, there have also been cases in which a subtotal colectomy was necessary due to extensive involvement of the intestine [ 5 ]. In addition, the appropriate local therapy for skin lesions should be remembered [ 26 , 38 ].…”