Extraintestinal Manifestations in Inflammatory Bowel Disease: The Experience at Cleveland Clinic Abu Dhabi, A Large Tertiary Hospital in United Arab Emirates

Background:
Extraintestinal manifestations (EIMs) are important and frequent associations in inflammatory bowel disease (IBD). EIMs affect both Crohn’s disease (CD) and ulcerative colitis (UC). It involves the musculoskeletal (peripheral arthritis, osteoporosis, ankylosing spondylitis, sacroiliitis), dermatology (aphthous stomatitis, erythema nodosum, pyoderma gangrenosum), renal (nephrolithiasis), hepatobiliary (primary sclerosing cholangitis), ocular (uveitis, sclerites, episcleritis), and vascular (thrombosis) systems. We aim to study the incidence and types of EIMs in IBD patients at Cleveland Clinic Abu Dhabi, one of the largest tertiary care hospital in United Arab Emirates. Methodology: A retrospective analysis was conducted on a cohort of IBD patients (n = 1142) to assess the incidence of EIMs across different demographics and disease types. Data were obtained from the IBD registry records at Cleveland Clinic Abu Dhabi between March 2015 and June 2024, focusing on different EIM such as musculoskeletal, dermatological, renal, hepatobiliary, ocular, and vascular manifestations.
Results:
Among the study cohort of 1142 patients, 436 patients (38%) presented with at least 1 EIM. The distribution across gender showed a slight predominance in males 253 (58%) vs females 183 (42%). CD exhibited a higher prevalence of EIMs compared to UC (58% vs 42%). Musculoskeletal manifestations were the most common (54%), followed by dermatological (14%), renal nephrolithiasis (13%), hepatobiliary primary sclerosing cholangitis (PSC) (12%), ocular (4%), and vascular manifestations (3%). Notably, PSC was predominantly associated with UC (72%) vs CD (28%).
Conclusions:
Extra-intestinal manifestations are prevalent among IBD patients, affecting a substantial proportion of individuals across various manifestations. Musculoskeletal manifestations were the most common presentation. Understanding these disease associations can aid in early detection, proactive management, and appropriate referral to different subspecialty to improve the outcomes in patients with IBD.