Should JAK inhibitors and anti-IL6 medications be avoided in patients with known diverticulosis?

The development of diverticulitis, including complications such as bowel perforation, has been reported in patients taking JAK and IL-6 inhibitors (for example, see here and here). As a result, a history of diverticulitis is a relative contraindication for these agents (and carry a “use with caution” warning). I recommend avoiding them in the setting of active diverticular disease; for those with a history of past diverticulitis that is currently quiescent, I would still avoid these drugs and only consider their use as a last resort (e.g., if all other reasonable options had failed). If used in such patients, close monitoring for any suggestion of recurrent diverticular disease would, of course, be warranted.

Regarding diverticulosis, there ...

A good and clinically relevant question. I will assume the patient has rheumatoid arthritis, even though I would do the same for others also. We have multiple other options for the treatment of RA, with different modes of action, which as far as my interpretation of the data goes, are similar to one another in efficacy in the individual patient level, and the main difference among these comes down to the side effect profile. So in a patient with known diverticulosis history, I would pick one of the other agents and reconsider a JAK inhibitor or an IL-6 agent if the others fail and the patient's RA is still active.