title: Chronological Order of Appearance of Extraintestinal Manifestations Relative to the Time of IBD Diagnosis in the Swiss Inflammatory Bowel Disease Cohort.
abstract: BACKGROUND
  Data evaluating the chronological order of appearance of extraintestinal manifestations (EIMs) relative to the time of inflammatory bowel disease (IBD) diagnosis is currently lacking. We aimed to assess the type, frequency, and chronological order of appearance of EIMs in patients with IBD.
  
  
  METHODS
  Data from the Swiss Inflammatory Bowel Disease Cohort Study were analyzed.
  
  
  RESULTS
  The data on 1249 patients were analyzed (49.8% female, median age: 40 [interquartile range, 30-51 yr], 735 [58.8%] with Crohn's disease, 483 [38.7%] with ulcerative colitis, and 31 [2.5%] with indeterminate colitis). A total of 366 patients presented with EIMs (29.3%). Of those, 63.4% presented with 1, 26.5% with 2, 4.9% with 3, 2.5% with 4, and 2.7% with 5 EIMs during their lifetime. Patients presented with the following diseases as first EIMs: peripheral arthritis 70.0%, aphthous stomatitis 21.6%, axial arthropathy/ankylosing spondylitis 16.4%, uveitis 13.7%, erythema nodosum 12.6%, primary sclerosing cholangitis 6.6%, pyoderma gangrenosum 4.9%, and psoriasis 2.7%. In 25.8% of cases, patients presented with their first EIM before IBD was diagnosed (median time 5 mo before IBD diagnosis: range, 0-25 mo), and in 74.2% of cases, the first EIM manifested itself after IBD diagnosis (median: 92 mo; range, 29-183 mo).
  
  
  CONCLUSIONS
  In one quarter of patients with IBD, EIMs appeared before the time of IBD diagnosis. Occurrence of EIMs should prompt physicians to look for potential underlying IBD.
authors.affiliation: 1Division of Gastroenterology and Hepatology, Department of Internal Medicine, University Hospital Zurich, Zurich, Switzerland; 2Department of Medicine, Division of Gastroenterology and Hepatology, Triemlispital Zurich, Zurich, Switzerland; 3Private Practice for Dermatology, Zurich, Switzerland; 4Department of Dermatology, University Hospital Zurich, Switzerland; 5Division of Genetics and Molecular Medicine, King's College, London, United Kingdom; 6Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland; 7Institute of Social and Preventive Medicine (IUMSP), University of Lausanne, Lausanne, Switzerland; 8Department of Medicine, Division of Gastroenterology and Hepatology, University Hospital Basel, Basel, Switzerland; 9Crohn's and Colitis Center, Clinique de La Source, Lausanne, Switzerland; 101st Department of Medicine, Semmelweis University, Budapest, Hungary; 11Department of Medicine, Gastroenterology, Spital Netz Bern Tiefenau, Bern, Switzerland; 12Inserm U954 and Department of Hepato-Gastroenterology, University Hospital of Nancy-Brabois, Université Henri Poincaré 1, Vandoeuvre-lès-Nancy, France; and 13Department of Medicine, Division of Gastroenterology and Hepatology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland.
authors.forename: Stephan R
authors.initials: SR
authors.lastname: Vavricka
authors.forename: Gerhard
authors.initials: G
authors.lastname: Rogler
authors.forename: Claudine
authors.initials: C
authors.lastname: Gantenbein
authors.forename: Muriel
authors.initials: M
authors.lastname: Spoerri
authors.forename: Mareike
authors.initials: M
authors.lastname: Prinz Vavricka
authors.forename: Alexander A
authors.initials: AA
authors.lastname: Navarini
authors.forename: Lars E
authors.initials: LE
authors.lastname: French
authors.forename: Ekaterina
authors.initials: E
authors.lastname: Safroneeva
authors.forename: Nicolas
authors.initials: N
authors.lastname: Fournier
authors.forename: Alex
authors.initials: A
authors.lastname: Straumann
authors.forename: Florian
authors.initials: F
authors.lastname: Froehlich
authors.forename: Michael
authors.initials: M
authors.lastname: Fried
authors.forename: Pierre
authors.initials: P
authors.lastname: Michetti
authors.forename: Frank
authors.initials: F
authors.lastname: Seibold
authors.forename: Peter L
authors.initials: PL
authors.lastname: Lakatos
authors.forename: Laurent
authors.initials: L
authors.lastname: Peyrin-Biroulet
authors.forename: Alain M
authors.initials: AM
authors.lastname: Schoepfer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001168:Arthritis / Q000175:diagnosis* / Q000209:etiology; D015331:Cohort Studies; D004893:Erythema Nodosum / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D017511:Pyoderma Gangrenosum / Q000175:diagnosis* / Q000209:etiology; D013167:Spondylitis, Ankylosing / Q000175:diagnosis* / Q000209:etiology; D013281:Stomatitis, Aphthous / Q000175:diagnosis* / Q000209:etiology; D013557:Switzerland; D013997:Time Factors; D055815:Young Adult