Extraintestinal manifestations

Common in Crohn’s disease with around 35% patients being affected (1).

It is more common with colonic Crohn's disease, but they may be present in any subtype (2).

Extraintestinal manifestations seen in Crohn’s disease include:

• mild iron-deficiency anaemia secondary to blood loss
• arthritis; ankylosing spondylitis is associated with Crohn's disease due to the common HLA-B27 antigen
• arthralgia
• clubbing
• skin tags
• hepatobiliary disease, ranging from pericholangitis to cirrhosis
• erythema nodosum
• megaloblastic anaemia
• pyoderma gangrenosum
• uveitis and episcleritis (1)
• rarely, amyloidosis as a result of long-standing Crohn's disease
• rarely granulomatous cheilitis may be a presenting feature of Crohn's Disease
• venous thromboembolism (1)

Extraintestinal manifestations may

• be related temporally to CD activity e.g. - Peripheral arthritis, erythema nodosum, oral aphthous ulcers and episcleritis
• occur independently e.g. - pyoderma gangrenosum, uveitis, axial arthropathy and primary sclerosing cholangitis (1)

Perianal fistulas are present in 10% of patients at the time of diagnosis, and may be the presenting complaint (2).

Reference:

• (1) Van Assche G et al. The second European evidence-based consensus on the diagnosis and management of Crohn's disease: Special situation. Journal of Crohn's and Colitis 2010; 4:63-101
• (2) Van Assche G et al. The second European evidence-based consensus on the diagnosis and management of Crohn's disease: Definitions and diagnosis. Journal of Crohn's and Colitis 2010; 4:7–27