IBD and Immune-Mediated Inflammatory Diseases: What Is the Optimal Management?

Background/Objectives: Inflammatory bowel diseases (IBD) including ulcerative colitis and Crohn's disease can be associated with other immune-mediated inflammatory diseases (IMIDs) and extraintestinal manifestations (EIM) including dermatological manifestations, ophthalmologic manifestations, musculoskeletal manifestations and neurological manifestations. The aim of this narrative review is to discuss the optimal management and treatment strategy of IBD with immune-mediated inflammatory disease and extraintestinal manifestations. Methods: This review is based on published studies searched in PubMed until 31 December 2025. Our search focused on systemic reviews, review articles, randomized trials, cohort studies, guidelines and case series. Results: In IBD, the presence of additional immune-mediated inflammatory diseases (IMIDs) should be considered a poor prognostic factor, prompting closer disease monitoring and earlier escalation to or optimization of advanced therapy. Therapeutic management requires careful consideration including a multidisciplinary approach and a selection of the most appropriate treatment option(s) based on the presence, severity of IBD and/or IMIDs and/or EIM. For patients with refractory disease affecting multiple organs, emerging strategies include dual biologic therapies. Conclusions: The optimal management of IBD with associated IMIDs/EIM should be multidisciplinary in close cooperation among specialists to align treatment goals and management plans.