Extra intestinal manifestations may increase the risk of synchronous and metachronous development of other extraintestinal manifestations in patients with Crohn’s disease

Although Crohn's disease (CD) affects the intestines, it is known to be a systemic disease rather than being limited to the intestines. Extra intestinal manifestations (EIMs) accompanying CD are reported at rates varying from 6 to 53%. While EIM negatively affects the quality of life of some patients, some EIMs, such as primary sclerosing cholangitis and thromboembolism, can be life-threatening. Although more than one EIM can occur simultaneously, the development of one EIM increases the probability of developing another EIM. There are few studies on how EIMs affect each other. The aim of this study was to examine the frequency of EIMs accompanying CD and their interactions with each other. This study included patients with CD who were under regular follow-up from March 1986 to October 2011. Accompanying EIMs and the time of development were recorded. The frequency of EIMs and their associations with each other were investigated. In total, 336 patients with CD (55.4% male) with a mean follow-up duration of 7.54 years (range, 6 months-25.4 years) were evaluated. At the time of CD diagnosis, 21.1% of the patients had at least one EIM, and at the end of the 25-year follow-up period, the prevalence of EIMs was 47.3%. The prevalence of multiple EIMs was 12.2% and 22.9% at the onset of CD and at the 25-year follow-up, respectively. Oral, joint 9.2%, respectively) were the most common EIMs. The development and skin involvement (32.4%, 24.7%, and of peripheral arthritis was significantly associated with axial spondiloarthropathy, skin involvement, ocular involvement, oral ulcers, and vascular thromboembolism (p < 0.05). There was a significant relationship between oral ulcers and peripheral arthritis, axial arthritis, skin involvement, ocular involvement, liver involvement and thromboembolism (p < 0.05). No significant relationship was detected between neurological involvement and any other EIMs. The development of EIMs in patients with CD may trigger the development of other EIMs during the course of the disease.