EXTRAINTESTINAL MANIFESTATIONS

EXTRAINTESTINAL MANIFESTATIONS

Arthritis occurs in around 15% of patients and is typically an asymmetrical large joint polyarthropathy , a ff ecting knees, ankles, elbows and wrists. Sacroiliitis and ankylosing spondy litis are 20 times more common in patients with UC than in the general population and are associated with the HLA-B27 genotype. Sclerosing cholangitis is associated with UC and can progr ess to cirrhosis and hepatocellular failure. Cholangiocar cinoma is a rare association, but its frequency is not influenced by colectomy (see Chapter 71 ). The skin lesions erythema nodosum and pyoderma gangrenosum are associated with UC and both normally resolve with good colitis control. The eyes can be a ff ected by uveitis and episcleritis. Extraintestinal manifestations

The extraintestinal manifestations of CD are similar to those that occur in UC. Primary sclerosing cholangitis is relatively rare in CD, compared with UC. Gallstones are common, as an inflamed or absent (because of resection) terminal ileum leads to reduced absorption of bile salts. Amyloidosis is common but is rarely symptomatic. Metastatic CD can occur in the vagina and/or skin with nodular ulcers, which demonstrate non-caseating granulomas when biopsied. Such cutaneous CD can be virtually indistinguishable macroscopically from hidradenitis suppurativa.