title: Extraintestinal manifestations of inflammatory bowel disease and the influence of smoking.
abstract: OBJECTIVE
  To define the number/frequency of organ systems affected by extraintestinal manifestations (EIMs), to identify factors affecting the clinical course of inflammatory bowel disease (IBD) and EIM development, and to determine the impact of smoking, disease duration and location on the diagnosis of EIMs in Crohn's disease (CD) and ulcerative colitis (UC).
  
  
  METHODS
  IBD patients were derived from a single university colorectal surgery practice. Smoking data were obtained through a modified Behavioral Risk Factor Surveillance System survey. The frequencies of arthritis/arthralgia, primary sclerosing cholangitis (PSC), ocular and cutaneous EIMs were determined.
  
  
  RESULTS
  Of the 757 patients evaluated (CD 488, UC 269), 50% had ≥1 EIM. Arthritis/arthralgia, cutaneous and ocular EIMs were significantly higher in frequency in CD compared to UC patients. Prolonged disease duration was associated with increased prevalence of arthritis/arthralgia in IBD (p ≤ 0.001) as well as PSC (p = 0.049), ocular (p = 0.030) and cutaneous (p = 0.009) EIMs in CD. Disease location affected the occurrence of EIMs in CD. Smoking appeared to increase the prevalence of ocular EIMs in UC (p = 0.026).
  
  
  CONCLUSIONS
  Arthritis/arthralgia, cutaneous and ocular EIMs occurred in a significantly higher proportion of CD patients. CD patients with longer disease duration had a significantly higher prevalence of PSC, ocular and cutaneous EIMs. Smoking was found to increase ocular EIMs in UC.
authors.affiliation: Department of Surgery, Price Institute of Surgical Research and Section of Colorectal Surgery, University of Louisville School of Medicine, Louisville, Ky., USA.
authors.forename: Henry
authors.initials: H
authors.lastname: Roberts
authors.forename: Shesh N
authors.initials: SN
authors.lastname: Rai
authors.forename: Jianmin
authors.initials: J
authors.lastname: Pan
authors.forename: J Michael
authors.initials: JM
authors.lastname: Rao
authors.forename: Robert C
authors.initials: RC
authors.lastname: Keskey
authors.forename: Ziad
authors.initials: Z
authors.lastname: Kanaan
authors.forename: Ethan P
authors.initials: EP
authors.lastname: Short
authors.forename: Edward
authors.initials: E
authors.lastname: Mottern
authors.forename: Susan
authors.initials: S
authors.lastname: Galandiuk
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001168:Arthritis / Q000209:etiology; D015209:Cholangitis, Sclerosing / Q000209:etiology; D002908:Chronic Disease; D003093:Colitis, Ulcerative / Q000150:complications*; D003424:Crohn Disease / Q000150:complications*; D003872:Dermatitis / Q000209:etiology; D005128:Eye Diseases / Q000209:etiology; D005260:Female; D006801:Humans; D007249:Inflammation / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D012907:Smoking / Q000009:adverse effects*; D013997:Time Factors