OBJECTIVE The aim of this study was to describe arthritis or vasculitis as initial manifestations of Crohn's disease (CD). METHODS We describe three cases in which the rheumatological manifestations preceded the bowel disease and one with rheumatological manifestation and asymptomatic gut inflammation. The information on clinical manifestations, laboratory examination results, imaging procedures, and histological data were gathered from the patients' medical charts. A MEDLINE search for the associations of extraintestinal manifestations of inflammatory bowel disease was performed. RESULTS Arthritis or vasculitis preceded the bowel disease by 3 to 15 months. In one case, the bowel disease remained asymptomatic throughout the follow-up period. CONCLUSIONS Rheumatological presentations of CD such as arthritis and vasculitis are uncommon. The diagnosis of CD without evident bowel symptoms might offer explanations and treatment options for puzzling symptoms and signs. Recognition, early diagnosis, and treatment of the underlying gut disease might prove useful for both the bowel disease and the rheumatological manifestations.