Abstract Background Extra-intestinal manifestations (EIMs) are reported in up to 50% of patients with inflammatory bowel disease (IBD) and often indicate more systemic, immune-mediated inflammatory activity. These manifestations may influence disease course and therapeutic outcomes, particularly under anti-tumour necrosis factor-alpha (anti-TNFα) therapy. However, data on the prevalence and clinical impact of EIMs remain scarce in our setting. The aim of this single-centre study was to assess the influence of EIMs on disease severity and response to anti-TNFα therapy in patients with IBD. Methods A retrospective study was conducted including all IBD patients treated with infliximab or adalimumab in our department between 2018 and 2025. Data were collected from patient records; incomplete files were excluded. Variables analysed included demographic and clinical characteristics, disease duration, Montreal classification, presence of extra-intestinal manifestations, and therapeutic outcomes under anti-TNFα agents. Results Seventy-nine patients (43 males, 36 females; mean age 42 years 14–72) were included, comprising 62 with Crohn’s disease and 17 with ulcerative colitis, all treated with anti-TNFα agents. EIMs were observed in 25 patients (40.3%), predominantly rheumatological (84%). The presence of EIMs was not significantly associated with disease type, smoking status, or disease duration (all p 0.05). However, EIMs showed a trend toward association with severe phenotypes (p = 0.089, OR = 2.6, 95% CI 0.9–7.8) and with loss of response to anti-TNFα therapy (p = 0.08, OR = 2.3, 95% CI 0.9–5.8). Conclusion EIMs were common in this Tunisian IBD cohort and tended to correlate with reduced durability of response to anti-TNFα agents. Although these associations did not reach statistical significance, the observed trends suggest that patients with systemic inflammatory involvement may require closer monitoring and earlier treatment optimisation to sustain long-term response. Conflict of interest: Ms. Bostani, Sonia: No conflict of interest El Haj Salameh, Aws: No conflict of interest Mohamed, Ghanem: No conflict of interest Bizid, Sondes: No conflict of interest Bouali, Riadh: No conflict of interest Ben Abdallah, Hatem: No conflict of interest
Bostani et al. (2026) studied this question.