Many patients and physicians have been inquiring about the latest treatment for Ulcerative Colitis (UC) with Abbott and Janssen having recently making Tumor Necrosing Factor (TNF) antagonists more readily available for the treatment of moderate to severe UC.
The incidence of UC has been increasing and there are now 2.2 to 14.3 cases per 100,000 per year with a prevalence of 37-246 cases per 100,000. UC can appear at any age equally in males or females but has a peak age of onset between 15 and 30 years. Symptoms include persistent bloody diarrhea, fever, weight loss, tenesmus, or abdominal pain. Extraintestinal complicating symptoms may include arthritis, sacroilitis, uveitis and episceritis, and pyoderma gangrenosum.
Mild disease with 1-3 bowel movements (BM), rectal bleeding less than 50% of the time, and endoscopic findings of erythema, friability, and punctate ulcerations may be treated with mesalamine and /or suppositories. Moderate disease with 3-5 BMs, rectal bleeding with almost all BMs, weight loss, and endoscopically more significant ulcerations may be treated with mesalamine and/or steroids (prednisone or budesonide) or immunomodulators (such as azathioprine/6-mercaptopurine).
Severe disease with greater than 5 bloody BMs, passage of blood without stool, worsening abdominal pain, weight loss and malnutrition, and severe confluent wide spread ulcerations require steriods (IV), possible hospitalization, and/or TNF antagonists (Adalimumab, Golimumab, and Infliximab).
These agents require a PPD or quantiferon gold level, hepatitis B sAg and sAb, and Coccidiomycosis / histoplasmosis titer (depends on exposure risk). Lymphoma rates are very rare with <0.1 event per 100 patient-years. A Lupus like syndrome is equally rare. Cyclosporine has been used in the past as last resort before surgery. Surgical colectomy cures the intestinal component of UC but the risk of extraintestinal manifestation such as Primary Sclerosing Cholangitis remain. Educating our patients is very important. There are many online resources such as the Crohns and Colitis Foundation of America (www.ccfa.org) and patients also have an option to download the ebook Ulcerative Colitis for Dummies (www.ucfordummies.com) for free.
