Abstract Background Rheumatologic extraintestinal manifestations (EIMs) are the most common extraintestinal manifestations of inflammatory bowel disease (IBD), yet data from Latin America remain scarce. In this study, we aimed to assess the prevalence, clinical characteristics, and associated factors of rheumatologic EIMs in a large multicenter Brazilian IBD cohort. Methods We performed a cross-sectional analysis of the CNP database (Brazil, as of September 2025), including 4,627 patients diagnosed with Crohn’s disease (CD), ulcerative colitis (UC), or non-classified colitis (IC). Patients were stratified into two groups: those with rheumatologic manifestations and those without. We compared clinical features, IBD subtype, age at diagnosis, gastrointestinal symptoms, and the presence of other EIMs (dermatologic, ophthalmologic, hepatobiliary, nephrologic, thrombotic, and others) between groups. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated, and chi-square tests were used for categorical comparisons. Results Rheumatologic EIMs were observed in 19.8% of patients (n = 917), distributed as 56.2% in Crohn’s disease, 43.3% in ulcerative colitis, and 0.5% in non-classified colitis. The most common manifestation was peripheral arthritis/arthralgia (84.5%), followed by sacroiliitis/ankylosing spondylitis (15.2%) and psoriatic arthritis (1.2%). Patients with rheumatologic EIMs were diagnosed at a statistically significantly higher mean age (36.8 vs 35.2 years, p 0.0001), although the absolute difference between groups was small.They showed increased frequencies of diarrhea (64.1% vs. 60.2%; OR 1.19, 95% CI 1.02–1.38), abdominal pain (62.5% vs. 56.8%; OR 1.27, 95% CI 1.10–1.48), and rectal bleeding (44.3% vs. 38.9%; OR 1.25, 95% CI 1.08–1.45). Rheumatologic EIMs were strongly associated with dermatologic (OR 2.21, 95% CI 1.69–2.90), ophthalmologic (OR 4.40, 95% CI 2.92–6.64) and nephrologic manifestations (OR 2.78, 95% CI 1.89–4.11). Conclusion In this large Brazilian IBD cohort, rheumatologic EIMs were present in approximately one-fifth of patients, predominantly manifesting as peripheral arthritis/arthralgia. Their presence was associated with a greater gastrointestinal symptom burden and a markedly elevated risk of concurrent dermatologic, ophthalmologic, and nephrologic EIMs. These findings underscore the imperative for integrated, multidisciplinary care of IBD patients and support the existence of an EIM-clustering phenotype in Latin American populations. References: 1. Faggiani I et al.. Extraintestinal Manifestations in Inflammatory Bowel Disease: From Pathophysiology to Treatment. Biomedicines. 2024 Aug 13;12(8):1839. doi: 10.3390/biomedicines12081839. PMID: 39200303. 2. Giovannini I et al. Arthralgia and Extraintestinal Manifestations in Crohn’s Disease Elevate the Risk of IBD-Related Arthritis over Sacroiliitis. Rheumatol Ther. 2025 Feb;12(1):99-108. doi: 10.1007/s40744-024-00728-4. Epub 2024 Dec 14. PMID: 39673666. Conflict of interest: Luporini, Rafael: Personal fees: received honoraria as speaker from Takeda, AbbVie, and Johnson & Johnson. Non-financial support: received congress expenses coverage. Parra, Rogerio: Dr. Parra RS has received honoraria related to lectures, advisory board participation, or clinical study involvement from the following companies: AbbVie, Johnson & Johnson, Pfizer, Ferring, Lilly, MSD, and Takeda. Parente, Jose Miguel: Speaker from Janssen, Takeda, Pfizer and Abbvie Sousa, Gabryel Felipe Alves de: No conflict of interest Amorim, Gabriel Stumpf Bastos: No conflict of interest Yukie Sassaki, Ligia: No conflict of interest Hossne, Rogério: Speaker: J & J, Abbive, Takeda, Pfizer. Advisory Board: J & J, Abbive, Takeda, Pfizer Baima, Julio: No conflict of interest Froes, Renata: Speaker: J & J, Takeda, Abbvie, Pfizer, Ferring, Sanofi, Celltrion, Nestle, GSK, CSL Vifor. Advisory board: J & J, Takeda, Abbvie, Pfizer. Barreto, Karen: No conflict of interest Rios Do Nascimento, Catiane: No conflict of interest Kaiser Junior, Roberto Luiz: No conflict of interest Faria, Mikaell Alexandre Gouvea: No conflict of interest Joudatt, Juliano: No conflict of interest Zabot Pandolfo, Gilmara: None Cunha, Ricardo Valli da: No conflict of interest Zaltman, Cyrla: Received fee as speaker or as an advisory board member for Abbvie, Takeda, Pfizer, Johnson & Johnson, and received research funding from Johnson & Johnson, Takeda, Lilly, Pfizer Siffert de Souza, Heitor: none Coelho Demetrio, Wanda: None Pereira de Almeida de Morais, Neogelia: No conflict of interest Ribas Andrade, Adriana: Speaker of Takeda, Janssen and Abbvie Marques dos Santos, Carlos Henrique: none Salgado, Valeria: No conflict of interest Cancela E Penna, Francisco Guilherme: Abbvie, Johnson & Johnson, Takeda, MSD De Souza Menegassi, Vivian: no conflict of interest Andrade, Guilherme Marques: No conflict of interest Maximiano, Fabio Luiz: No conflict of interest Oliveira Santana Silva, Genoile: Honoraria - Abbvie, Johnson & Johnson, Ferring, Takeda. Research - Abivax, Takeda, Johnson & Johnson, Roche, Sanofi, Polpharma. Advisory board - Abbvie, Johnson & Johnson, MSD. Faria, Ricardo: No conflict of interest Machado de Souza, Mardem: No conflict of interest Bafutto, Mauro: NONE Loures, Marcela: Abbvie Takeda J & J Quaresma, Abel: Speaker Jansen and Celltrion Flores, Cristina: Personal Fees: Advisory boards Abbvie, Pfizer, J & J, Takeda, MSD, Amgen Speaker Abbvie, Takeda, J & J, Amgen. Clinical reserach: Abbvie, MSD, J & J. Andrade, Lais: Received speaker fees from Johnson & Johnson and travel/congress support from Johnson & Johnson, Takeda, and AbbVie. Silva, Amanda: None Borges, Valéria Ferreira De Almeida E: There are no conflicts of interest to declare. Cassol, Ornella: No conflict of interest Mizsputen, Sender Jankiel: No conflict of interest Vilela, Eduardo: None
Luporini et al. (2026) studied this question.