Inflammatory bowel diseases (IBDs), including Crohn's disease and ulcerative colitis, frequently present with extra-intestinal manifestations. Virtually all patients with IBD could be at risk for developing inflammatory arthropathies within the spectrum of spondyloarthritis (SpA). In this context, prompt recognition of musculoskeletal "red flags" (lower back pain, dactylitis, enthesitis, swelling of peripheral joints, musculoskeletal chest pain, family history of SpA, psoriasis, and anterior uveitis) is crucial for early referral and multidisciplinary management by gastroenterologists and rheumatologists. Recent advances have refined diagnostic tools including questionnaires, alongside imaging modalities and laboratory markers, enhancing the detection of SpA in IBD patients. Effective treatment strategies targeting both gastrointestinal and musculoskeletal symptoms may significantly reduce long-term morbidity in these patients. In this narrative review, we aimed to underscore the importance of integrating clinical, diagnostic, and therapeutic approaches for optimal patient management and outcome over time.