INTRODUCTION: Axial spondyloarthritis (axSpA) is a chronic inflammatory disease with heterogeneous clinical manifestations, including extra-articular manifestations (EAMs) such as acute anterior uveitis (AAU), inflammatory bowel disease (IBD), and psoriasis. This study aimed to assess the impact of EAMs on disease characteristics in axSpA patients. MATERIALS AND METHODS: A cross-sectional study was conducted in a Moroccan rheumatology department over 12 years. Patients diagnosed with axSpA according to ASAS 2009 criteria were included. Those with at least one EAM were compared with those without EAMs. RESULTS: Among 400 axSpA patients (54% women, mean age 45.84 +/- 14.42 years, median disease duration 7.49 +/- 6.89 years). EAMs were observed in 30.3%. The three commonest EAMs were IBD (18.5%), AAU (12.5%) and psoriasis (2%). Compared with those without EAMs, patients with EAMs had significantly longer disease duration (p = 0.014), more frequent cervical pain (p = 0.040), thoracic back pain (p = 0.043), spinal stiffness (p < 0.0001), and buttock pain (p = 0.024). They also exhibited more radiographic sacroiliitis (p < 0.0001), higher disease activity (p = 0.05), and worse physical function (p = 0.004). Nonsteroidal anti-inflammatory drugs use was less frequent (p = 0.021), whereas sulfasalazine (p = 0.043) and TNF-alpha inhibitors (p < 0.0001) were more commonly used. Worse physical function (BASFI) was the main independent factor associated with EAMs. CONCLUSION: EAMs, particularly IBD and AAU, are prevalent in axSpA. Their presence significantly affects clinical outcomes and patient-reported measures, highlighting their importance in disease management.