Extraintestinal Complications of IBD

Affecting as many as 30% of patients with Crohn’s or colitis, arthritis, or inflammation of the joints, is the most common extraintestinal complication of IBD.  Although arthritis is typically associated with older age, in IBD it often strikes younger patients as well. In addition to joint pain, arthritis also causes swelling of the joints and a reduction in flexibility. Typically arthritis in IBD improves as the intestinal disease symptoms improve.

Common types of arthritis experienced by IBD patients include:

• Peripheral arthritis (arthritis typically affecting the large joints of the arms and legs, including the elbows, wrists, knees, and ankles)
• Axial arthritis (also known as spondylitis or spondyloarthropathy, this type of arthritis typically affects the lower spine and sacroiliac joints at the bottom of the back)
• Ankylosing spondylitis (a more severe form of spinal arthritis, AS is an uncommon complication, affecting between 2% and 3% of people with IBD)

Click here to learn more about arthritis in IBD.

Up to 20% of people with IBD experience skin extraintestinal complications. The skin complications may be due to the disease itself or caused by certain medications used for treating IBD.

Some common skin complications of IBD include:

• Erythema nodosum (tender red bumps typically on the shins that can affect 2-10% of IBD patients)
• Pyoderma gangrenosum (skin lesions that join together and form deep chronic ulcers that tend to occur at ostomy sites or locations of trauma)
• Skin tags (small flaps of skin often found around the anus that can become inflamed and uncomfortable)
• Enterocutaneous fistulas (abnormal channels that form from the intestine to the skin)
  • Perianal fistulas are a common type of enterocutaneous fistulas. These affect about one-third of Crohn’s patients and occur between the intestines and the skin around the anus that can drain blood, pus, and/or stool.
• Anal fissures (small tears in the lining of the anal canal that cause pain with defecation)
• Aphthous stomatitis (also known as canker sores, these are small mouth ulcers)

Click here to learn more about skin manifestations of IBD.

As many as 30% to 60% of IBD patients have lower-than-average bone density. This can occur as osteoporosis (a condition that literally means “porous bones”) or osteopenia (low bone density), osteomalacia (softening of the bones). Prolonged use of corticosteroids, active inflammation, or vitamin D deficiency may contribute to these conditions.

Click here to learn more about bone loss in IBD. 

Approximately 10% of IBD patients experience eye problems including:

• Uveitis (painful inflammation of the uvea, middle layer of the eye wall)
• Keratopahy (an abnormality of the cornea)
• Episcleritis (inflammation of the outer coating of the white of the eye)
• Dry eyes (caused by a vitamin A deficiency)

These eye complications can be caused by IBD itself or by some medications used to treat the diseases. Most of these are treatable conditions and do not pose any significant threat to loss of vision. 

Click here to learn more about eye complications in IBD.

The kidneys filter the body’s blood supply and eliminate waste through urine. Medications can occasionally cause kidney complications. However, once the medication is stopped, kidney function usually returns to normal. Serious kidney complications associated with IBD are rare, but some less serious ones may occur, including:

• Kidney stones
• Hydronephrosis (an obstruction of one of the ureters, the tubes connecting the kidney to the bladder)
• Fistulas (abnormal connections between the intestines and adjacent organs, such as the bladder or ureter)
• Amyloidosis (an abnormal deposit of a protein in various organ tissues, such as the kidneys)
• Glomerulonephritis (inflammation in the kidney that hinders its filtering ability)

Click here to learn more about kidney complications in IBD.

In some IBD patients, the liver can become inflamed or damaged. Most liver damage is reversible, but serious liver disease can affect about 5% of people with IBD. Some liver manifestations of IBD include:

• Fatty Liver Disease (also known as hepatic steatosis, occurs when extra fat gets deposited in the liver, squeezing out normal liver cells)
• Hepatitis (inflammation of the liver)
• Gallstones
• Primary Sclerosing Cholangitis (commonly referred to as PSC, this is inflammation specific to the bile ducts causing scarring and eventually cirrhosis of the liver)

Click here to learn more about liver complications of IBD.

Approximately one in three patients with IBD has anemia (low red blood cell count). Causes of anemia include:

• Low iron caused by:
  • Inflammation in your intestines interfering with your body's ability to use or absorb iron
  • Blood loss from intestinal bleeding
• Poor absorption of vitamins and minerals, like vitamin B12 or folic acid)
• Use of certain medications

Click here to learn more about anemia and IBD, or watch this webinar below.