Disease patterns in Crohn's disease and ulcerative colitis that you probably don't know yet
Joint pain, spots or problems with your eyes? In addition to the characteristic symptoms of Crohn's disease and Ulcerative colitis there are other clinical pictures that are less well known. In this article, we will introduce you to some of these clinical pictures outside the intestinal tract that can occur in addition to the IBD symptoms of chronic inflammatory bowel disease (IBD). We also discuss their treatment options.
The clinical pictures of Crohn's disease and ulcerative colitis described in this article do not claim to be exhaustive and do not replace a visit to the doctor!
If you notice any of these symptoms, always consult your doctor.
- Disease patterns in Crohn's disease and ulcerative colitis that you probably don't know yet
A few figures on lesser-known diseases
In around 20-40 % of patients with Crohn's disease, other clinical pictures that do not affect the gastrointestinal tract develop during the course of the disease. These clinical pictures are referred to as extraintestinal manifestations. 50 % of patients with inflammatory bowel disease develop at least one of these extraintestinal manifestations in addition to their IBD symptoms.
There is a difference in frequency between Crohn's disease and ulcerative colitis. For example, extraintestinal manifestations occur more frequently in Crohn's disease than in ulcerative colitis.
Extraintestinal manifestations are clinical pictures that occur outside the gastrointestinal tract and are frequently found in patients with Crohn's disease or ulcerative colitis. These include joint complaints, eye diseases and skin manifestations.
Joint problems as one of the symptoms of IBD
The terms joint complaints, rheumatism, arthrosis and arthritis refer to various complaints in the joints. Rheumatism is the generic term for 100 different diseases that manifest themselves through differently localized chronic pain. These joint complaints can also be a side effect of chronic inflammatory bowel disease and occur in addition to the IBD symptoms. Enteropathic spondyloarthritis is most common in Crohn's disease and ulcerative colitis. This causes inflammation in the spine, between individual joints, in the knees, hips or in a part of the hand that connects the metacarpal bone to the fingers. The pain usually occurs together with episodes of chronic inflammatory bowel disease.
Joint pain can occur at different times. For example, the pain can occur before a diagnosis of chronic inflammatory bowel disease is made. However, it can also appear for the first time up to ten years after the diagnosis of Crohn's disease or ulcerative colitis. Patients with ulcerative colitis are more frequently affected by joint pain in the arms and legs. Crohn's disease patients, on the other hand, complain more frequently of pain in the sacrum. In total, 10-15 % of people affected by chronic inflammatory bowel disease also have symptoms of a rheumatic disease.
Joint problems are always treated with regard to the underlying disease, i.e. Crohn's disease or ulcerative colitis. In this context, COX-2 inhibitors have shown promise in treating joint pain in IBD. Non-steroidal anti-inflammatory drugs should be avoided as they can cause flare-ups. Patients with ulcerative colitis and joint pain can also be treated with sulphasalazine.
Another clinical picture with your IBD: eye problems
In addition to dry and itchy eyes, which can also occur as a side effect of medication in patients with Crohn's disease and ulcerative colitis, episcleritis can also occur. This is a Inflammation of the white sclera of the eye. It can be treated with steroidal and non-steroidal eye drops.
Iridocyclitis can also occur. The iris and ciliary body become inflamed. The eye is painful, red, sensitive to light and watery. It is treated with antibiotics and glucocorticoids.
Around 10 % of patients with Crohn's disease or ulcerative colitis are affected by eye diseases. They occur more frequently with an increase in IBD symptoms.
Skin diseases with IBD
Problems with the skin, the largest organ in the human body, can also occur in patients with Crohn's disease and ulcerative colitis. Around a third of IBD patients are affected.
Differentiation of the skin disease
In the case of skin problems, a distinction is made between specific and reactive lesions. Specific lesions mainly occur in Crohn's disease. These are fistulas and fissures. Reactive lesions occur in both ulcerative colitis and Crohn's disease. The two most common reactive lesions are erythema nodosum and pyoderma gangraenosum. We will introduce you to these in more detail.
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Erythema nodosum a lesser known clinical picture in IBD
Erythema nodosum involves small nodules under the skin that appear red to bluish on the front of the legs. Over time, they can turn brownish in color. This skin condition is very sensitive to touch and painful. In addition to saline compresses and cooling, treatment with corticosteroids is also recommended.
Another clinical picture: Pyoderma gangraenosum
In addition to erythema nodosum, pyoderma gangraenosum also occurs more frequently in patients with Crohn's disease and ulcerative colitis. These are pustules that spread rapidly and have a clear center. The transition between pustular and healthy skin is bluish in color. These pustules can be painful. The cause of this disease is an overshooting of the immune system, which then manifests itself on the skin.
Wound dressings and dressings are used to treat this clinical picture. Anti-inflammatory or immunosuppressive therapy can also help with IBD in particular. Anti-TNF-alpha can also help with this disease in connection with chronic inflammatory bowel disease.
Primary sclerosing cholangitis as a further clinical picture in addition to IBD
Another extraintestinal manifestation is primary sclerosing cholangitis (PSC). This is an inflammation of the bile ducts in and around the liver. This leads to a blockage of the bile ducts and can lead to cirrhosis as the disease progresses. Patients with ulcerative colitis are affected by the disease with above-average frequency, namely 80 %. In most cases, it is a right-sided colitis. However, 15 % of patients with Crohn's disease can also develop PSC if the colon is involved. PSC affects men three times more often than women. The disease occurs independently of the symptoms of chronic inflammatory bowel disease and is manifested either by no symptoms or by fatigue, itching, weight loss, fever, yellowing of the skin or bacterial cholangitis. On average, it takes two years before PSC is diagnosed.
In the case of primary sclerosing cholangitis, treatment with ursodeoxycholic acid is recommended to treat the itching. If there are constrictions in the bile ducts, these are widened using stents. However, these should not be in place for more than two to three weeks. Bacterial cholangitis is counteracted with an antibiotic. In the final stage of PSC, a liver transplant may be necessary.
QuickFacts:
- The symptoms of these clinical pictures usually worsen if there is also a relapse of IBD.
- In addition to the well-known symptoms of chronic inflammatory bowel disease such as Crohn's disease and ulcerative colitis, other illnesses can also occur. These include joint problems, skin diseases, liver problems and eye diseases.
- Many of these conditions are easily treatable. Always talk to your doctor individually about which treatment is suitable for you.
Antwerpes, F., & Levenfus, I. (2014, April 2). Episcleritis. DocCheck Flexikon. Retrieved September 11, 2025, from https://flexikon.doccheck.com/de/Episkleritis
DocCheck Flexikon. Iridocyclitis. Retrieved September 11, 2025, from https://flexikon.doccheck.com/de/Iridozyklitis
DocCheck Flexikon.Enteropathic arthritis. Retrieved September 11, 2025, from https://flexikon.doccheck.com/de/Enteropathische_Arthritis
DocCheck Flexikon. Seronegative spondylarthritis. Retrieved September 11, 2025, from https://flexikon.doccheck.com/de/Seronegative_Spondylarthritis
Dodegge, M., Teuber, C., Antwerpes, F., Güler, I., & others. (2024, July 18). Erythema nodosum. DocCheck Flexikon. Retrieved September 11, 2025, from https://flexikon.doccheck.com/de/Erythema_nodosum
Doßow, L., & von Arnim, U. (2019, August 13). Extraintestinal manifestations in IBD. The clinician. https://doi.org/10.1055/a-0969-1642
Hircin, E., Antwerpes, F., Weinreich, F., van den Höfel, N., Fink, B., & others. (2025, August 12). Pyoderma gangraenosum. DocCheck Flexikon. Retrieved September 11, 2025, from https://flexikon.doccheck.com/de/Pyoderma_gangraenosum
Hettegger, C., Güler, I., Antwerpes, F., Fink, B., & others. (2025, September 1). Primary sclerosing cholangitis. DocCheck Flexikon. Retrieved September 11, 2025, from https://flexikon.doccheck.com/de/Prim%C3%A4r_sklerosierende_Cholangitis
Krones E, Fickert P. Extraintestinal manifestations in chronic inflammatory bowel disease. Journal for Gastroenterological and Hepatological Diseases 2013; 11 (1), 15-20
Bokemeyer, B., & Lakomek, H.-J. (2018, April 4). Rheumatism and IBD (spondyloarthritis). Arthritis and rheumatism. https://doi.org/10.1055/s-0038-1636987
Rheumatism and gout. M-Clinic. Retrieved September 11, 2025, from https://www.mclinic.de/fachbereiche/mhand/gelenke-knorpel/rheuma-und-gicht
Image sources:
https://www.pcds.org.uk/clinical-guidance/erythema-nodusum
https://flexikon.doccheck.com/de/Pyoderma_gangraenosum
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