title: Extra-Gastrointestinal Manifestations of Inflammatory Bowel Disease May Be Less Common Than Previously Reported.
abstract: Extra-intestinal manifestations are well recognized in inflammatory bowel disease (IBD). To what extent the commonly recognized extra-intestinal manifestations seen in IBD patients are attributable to IBD is, however, not clear due to the limited number of controlled studies published.
  
  
  
  We have conducted a study of these manifestations using electronic primary care records. We have identified extra-intestinal manifestations in IBD and non-IBD patients and derived odds ratios (ORs) using conditional logistic regression.
  
  
  
  A total of 56,097 IBD patients (32.5 % Crohn's disease, 48.3 % ulcerative colitis (UC) and 19.2 % not classified) were matched to 280,382 non-IBD controls. We found records of pyoderma gangrenosum (OR = 29.24), erythema nodosum (OR = 5.95), primary sclerosing cholangitis (OR = 188.25), uveitis (OR = 2.81), ankylosing spondylitis (OR = 7.07), sacroiliitis (OR = 2.79) and non-rheumatoid inflammatory arthritides (OR = 2.66) to be associated with IBD. One or more of these was recorded in 8.1 % of IBD patients and 2.3 % of controls. Non-specific arthritides were present in many more patients, affecting 30 % of IBD patients and 23.8 % of controls overall. We also found weaker associations with a number of conditions not generally considered to be extra-intestinal manifestations including psoriasis, ischemic heart disease, multiple sclerosis and hay fever.
  
  
  
  Although "classical" extra-intestinal manifestations are strongly associated with IBD, most IBD patients remain unaffected. Arthropathies, perceived to be the commonest extra-intestinal manifestation, are not strongly associated with IBD, and the proportion of arthropathies attributable to IBD is likely to be small.
authors.affiliation: Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK. tim.card@nottingham.ac.uk.|Nottingham Digestive Diseases Centre Biomedical Research Unit, University of Nottingham, Nottingham, UK. tim.card@nottingham.ac.uk.
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Card
authors.affiliation: Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Sinéad M
authors.initials: SM
authors.lastname: Langan
authors.affiliation: Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK.
authors.forename: Thomas P C
authors.initials: TP
authors.lastname: Chu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001168:Arthritis / Q000453:epidemiology; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D015209:Cholangitis, Sclerosing / Q000453:epidemiology*; D015331:Cohort Studies; D004893:Erythema Nodosum / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015212:Inflammatory Bowel Diseases / Q000453:epidemiology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000453:epidemiology; D015999:Multivariate Analysis; D017202:Myocardial Ischemia / Q000453:epidemiology; D016017:Odds Ratio; D011565:Psoriasis / Q000453:epidemiology; D017511:Pyoderma Gangrenosum / Q000453:epidemiology*; D012189:Retrospective Studies; D006255:Rhinitis, Allergic, Seasonal / Q000453:epidemiology; D058566:Sacroiliitis / Q000453:epidemiology*; D013167:Spondylitis, Ankylosing / Q000453:epidemiology*; D014605:Uveitis / Q000453:epidemiology*; D055815:Young Adult
keywords: Arthritis; Epidemiology; Inflammatory bowel diseases; Iritis; Pyoderma