Abstract Extraintestinal Manifestations (EIMs) of Inflammatory Bowel Diseases (IBD) are a frequent feature of disease, occurring in 25-40% of patients with IBD. While associations with IBD type, gender, and age at diagnosis are known, less is known about the associations between different EIMs and which patients are most likely to develop more than 1 EIM. The goal of our study was to better characterize which patients may be at higher risk of developing multiple EIMs. METHODS: A retrospective review of patients enrolled in the Study of Prospective Adult Research Cohort with IBD (SPARC IBD) registry was performed and demographics, clinical data, and patient-reported outcomes were analyzed. A total of 1,202 patients with data available on EIMs were included, where EIMs included IBD-associated arthropathy, ocular complications including uveitis/iritis, primary sclerosing cholangitis, erythema nodosum, pyoderma gangrenosum, and thrombotic complications. Welch’s t-test and Fisher’s exact test were used to assess differences among continuous and categorical variables between those with versus without EIMs, as well as for comparisons between individual EIM groups. RESULTS: Three hundred forty-seven patients with at least 1 EIM were identified, compared to 855 patients without any EIMs. Two hundred eight four patients were identified as having 1 EIM, 54 patients had 2 EIMs, and 9 patients had 3 EIMs. Patients with Crohn’s disease and women were more likely to have 2 or more EIMs (p-value = 0.00517 and 0.000285, respectively). Patients with ocular manifestations were likeliest to have at least 2 EIMs (with 27/37 or 73.0% having multiple), while those with pyoderma gangrenosum and IBD associated arthritis were least likely to have additional EIMs (p-value = 0.000500). Further, no patients with PSC developed pyoderma gangrenosum (Fisher’s multiple comparison p-value = 0.00187). Most patients with 3 EIMs had IBD-associated arthritis and/or erythema nodosum (88% having each), while only 1 patient (11%) with 3 EIMs had PSC (p-value = 0.00161). CONCLUSION: Women and patients with Crohn’s disease are more likely to develop multiple EIMs and patients with ocular EIMs are more likely to have another EIM. Understanding how individual EIMs relate to one another can be used to better identify patients at risk of developing future EIMs and may help with risk stratification when choosing treatments.