PREVALENCE OF EXTRA INTESTINAL MANIFESTATIONS IN ULCERATIVE COLITIS
Authors: Tanveer Anam , Jamil Aisha , Iqbal Someia 
Published: January 2025

Background: Ulcerative colitis (UC) is a chronic inflammatory bowel disease primarily affecting the colon but frequently associated with extra-intestinal manifestations (EIMs), which can involve the musculoskeletal, ocular, dermatological, hepatobiliary, and renal systems. These manifestations significantly impact disease prognosis and patient quality of life. The prevalence and distribution of EIMs vary across populations, and their relationship with disease severity and duration remains a subject of ongoing investigation. Early identification and appropriate management of EIMs are crucial in optimizing patient outcomes.
Objective: To determine the prevalence of EIMs in UC patients and assess their association with disease severity, duration, and demographic factors.
Methods: This cross-sectional study included 157 UC patients diagnosed based on clinical, endoscopic, histopathological, and radiological criteria. Demographic and clinical data, including disease duration and severity (assessed using the Mayo Score), were recorded. Patients were systematically evaluated for the presence of EIMs, categorized into musculoskeletal (arthritis, spondyloarthropathy, osteopenia/osteoporosis), ocular (uveitis, episcleritis), dermatological (erythema nodosum, pyoderma gangrenosum), hepatobiliary (primary sclerosing cholangitis, non-alcoholic fatty liver disease), renal (nephrolithiasis), and other systemic manifestations (oral ulcers, thromboembolic events). Statistical analyses, including chi-square and t-tests, were performed to explore associations between EIMs and disease severity, duration, and gender distribution, with a p-value <0.05 considered statistically significant.
Results: EIMs were present in 42.7% (67/157) of patients. Musculoskeletal manifestations were the most prevalent (18.4%), with peripheral arthritis affecting 12.7% and spondyloarthropathy 5.7%. Dermatological EIMs were observed in 12.8%, including erythema nodosum (8.3%) and pyoderma gangrenosum (4.5%). Ocular involvement was reported in 10.2%, with uveitis in 6.4% and episcleritis in 3.8%. Hepatobiliary manifestations affected 14.1%, with primary sclerosing cholangitis in 4.5% and non-alcoholic fatty liver disease in 9.6%. Renal manifestations (nephrolithiasis) were present in 2.5%, while other systemic complications, including oral ulcers (5.1%) and thromboembolic events (3.8%), were also noted. EIMs were significantly associated with severe disease activity (p <0.05) and longer disease duration, particularly in patients with UC for more than 10 years (p = 0.01). No significant gender differences were found in the overall prevalence of EIMs, though musculoskeletal EIMs were slightly more common in males and dermatological manifestations in females. Patients with EIMs reported significantly lower quality of life scores (60.3 ± 13.5 vs. 75.6 ± 10.2, p <0.001).
Conclusion: Extra-intestinal manifestations are prevalent in UC patients, with a strong correlation to disease severity and duration. These manifestations contribute to substantial morbidity and significantly impair quality of life. Early recognition and a multidisciplinary approach to managing EIMs are essential in improving patient outcomes.