What is Ulcerative Colitis?

Ulcerative colitis is an inflammatory condition of the colon. The inflammation is usually limited to the rectum and lower colon, but it may also involve the entire colon.

Ulcerative colitis differs from another inflammatory bowel disease (IBD), Crohn’s disease. Crohn’s can affect any part of the gastrointestinal (GI) tract from mouth to anus. Ulcerative colitis, on the other hand, affects only the colon.

Doctors perform tests to determine the location/type of ulcerative colitis. Symptoms may vary depending on the extent of inflammation in the rectum and the colon.

Ulcerative colitis is often limited to the rectum or lower colon but can involve the entire colon.

Prevalence of Ulcerative Colitis

About 700,000 people in the United States have ulcerative colitis, with males and females affected equally. On average, people are diagnosed with ulcerative colitis in their mid-30s, although the disease can occur at any age.

Who Gets Ulcerative Colitis?

Though the cause of ulcerative colitis is not fully understood, researchers believe it to be a result of a combination of factors involving genetics, the environment, and the immune system. Here are some of the things that are known:

Genetic factors

About 20 percent of patients have a close relative with ulcerative colitis.

Most often, the patient with ulcerative colitis will also have a relative with ulcerative colitis
However, based on current research, there is no way to predict which, if any, family members will develop ulcerative colitis

The prevalence of ulcerative colitis is higher among white people of European origin and among people of Jewish heritage.

Environmental factors

Ulcerative colitis is more common in urban than in rural areas, and more common in northern than in southern climates.

Immune system factors

Researchers believe substances in the intestine are mistaken for foreign or invading substances (antigens). These antigens may be the direct cause of the inflammation, or they may stimulate the body's defenses to produce an inflammatory reaction. Normally, your immune system causes temporary inflammation to combat these antigens, and then the inflammation will be reduced as you regain health. In people with ulcerative colitis, however, this inflammation can persist long after your immune system should have finished its job.

Dietary factors

Some people believe that ulcerative colitis may be triggered by the foods we eat. However, no studies have suggested that diet can either cause or treat ulcerative colitis and there is no specific diet that patients with the disease should follow although it is advisable to eat a balanced diet. Likewise, there is no convincing evidence that ulcerative colitis results from food allergies.

Ulcerative colitis diagnosis

To diagnose ulcerative colitis, doctors evaluate the patient's history, physical exams, and a variety of laboratory tests. These tests include:

Blood tests
Stool tests
Flexible sigmoidoscopy
Colonoscopy
Computerized tomography (CT) scan
Barium enema x-ray

Ulcerative colitis can be difficult to diagnose, because symptoms can be similar to other intestinal disorders. Patients with suspected ulcerative colitis can be referred to gastroenterologists who specialize in ulcerative colitis and other IBDs.

Important Safety Information About HUMIRA^® (adalimumab)¹

What is the most important information I should know about HUMIRA?

You should discuss the potential benefits and risks of HUMIRA with your doctor. HUMIRA is a TNF blocker medicine that can lower the ability of your immune system to fight infections. You should not start taking HUMIRA if you have any kind of infection unless your doctor says it is okay.

Serious infections have happened in people taking HUMIRA. These serious infections include tuberculosis (TB) and infections caused by viruses, fungi, or bacteria that have spread throughout the body. Some people have died from these infections. Your doctor should test you for TB before starting HUMIRA, and check you closely for signs and symptoms of TB during treatment with HUMIRA. If your doctor feels you are at risk, you may be treated with medicine for TB.
Cancer. For children and adults taking TNF blockers, including HUMIRA, the chance of getting lymphoma or other cancers may increase. There have been cases of unusual cancers in children, teenagers, and young adults using TNF blockers. Some people have developed a rare type of cancer called hepatosplenic T-cell lymphoma. This type of cancer often results in death. If using TNF blockers including HUMIRA, your chance of getting two types of skin cancer (basal cell and squamous cell) may increase. These types are generally not life-threatening if treated; tell your doctor if you have a bump or open sore that doesn’t heal.

What should I tell my doctor BEFORE starting HUMIRA?

Tell your doctor about all of your health conditions, including if you:

Have an infection, are being treated for infection, or have symptoms of an infection
Get a lot of infections or infections that keep coming back
Have diabetes
Have TB or have been in close contact with someone with TB, or were born in, lived in, or traveled where there is more risk for getting TB
Live or have lived in an area (such as the Ohio and Mississippi River valleys) where there is an increased risk for getting certain kinds of fungal infections, such as histoplasmosis, coccidioidomycosis, or blastomycosis
Have or have had hepatitis B
Are scheduled for major surgery
Have or have had cancer
Have numbness or tingling or a nervous system disease such as multiple sclerosis or Guillain-Barré syndrome
Have or had heart failure
Have recently received or are scheduled to receive a vaccine. HUMIRA patients may receive vaccines, except for live vaccines
Are allergic to rubber, latex, or any HUMIRA ingredients
Are pregnant, planning to become pregnant, breastfeeding, or planning to breastfeed

Also tell your doctor about all the medicines you take. You should not take HUMIRA with ORENCIA^® (abatacept), KINERET^® (anakinra), REMICADE^® (infliximab), ENBREL^® (etanercept), CIMZIA^® (certolizumab pegol), or SIMPONI^® (golimumab). Tell your doctor if you have ever used RITUXAN^® (rituximab), IMURAN^® (azathioprine), or PURINETHOL^® (mercaptopurine, 6-MP).

What should I watch for AFTER starting HUMIRA?

HUMIRA can cause serious side effects, including:

Serious infections. These include TB and infections caused by viruses, fungi, or bacteria. Symptoms related to TB include a cough, low-grade fever, weight loss, or loss of body fat and muscle.
Hepatitis B infection in carriers of the virus. Symptoms include muscle aches, feeling very tired, dark urine, skin or eyes that look yellow, little or no appetite, vomiting, clay-colored bowel movements, fever, chills, stomach discomfort, and skin rash.
Allergic reactions. Symptoms of a serious allergic reaction include hives, trouble breathing, and swelling of your face, eyes, lips, or mouth.
Nervous system problems. Signs and symptoms include numbness or tingling, problems with your vision, weakness in your arms or legs, and dizziness.
Blood problems. Symptoms include a fever that does not go away, bruising or bleeding very easily, or looking very pale.
Heart failure (new or worsening). Symptoms include shortness of breath, swelling of your ankles or feet, and sudden weight gain.
Immune reactions including a lupus-like syndrome. Symptoms include chest discomfort or pain that does not go away, shortness of breath, joint pain, or rash on your cheeks or arms that gets worse in the sun.
Liver problems. Symptoms include feeling very tired, skin or eyes that look yellow, poor appetite or vomiting, and pain on the right side of your stomach (abdomen).
Psoriasis (new or worsening). Symptoms include red scaly patches or raised bumps that are filled with pus.

Call your doctor or get medical care right away if you develop any of the above symptoms.

Common side effects of HUMIRA include injection site reactions (redness, rash, swelling, itching, or bruising), upper respiratory infections (sinus infections), headaches, rash, and nausea. These are not all of the possible side effects with HUMIRA. Tell your doctor if you have any side effect that bothers you or that does not go away.

Remember, tell your doctor right away if you have an infection or symptoms of an infection, including:

Fever, sweats, or chills
Muscle aches
Cough
Shortness of breath
Blood in phlegm
Weight loss
Warm, red, or painful skin or sores on your body
Diarrhea or stomach pain
Burning when you urinate
Urinating more often than normal
Feeling very tired

HUMIRA is given by injection under the skin.

This is the most important information to know about HUMIRA. For more information, talk to your health care provider.

Uses

HUMIRA is a prescription medicine used:

To reduce the signs and symptoms of:
- Moderate to severe rheumatoid arthritis (RA) in adults. HUMIRA can be used alone, with methotrexate, or with certain other medicines. HUMIRA may prevent further damage to your bones and joints and may help your ability to perform daily activities.
- Moderate to severe polyarticular juvenile idiopathic arthritis (JIA) in children 4 years of age and older. HUMIRA can be used alone, with methotrexate, or with certain other medicines.
- Psoriatic arthritis (PsA) in adults. HUMIRA can be used alone or with certain other medicines. HUMIRA may prevent further damage to your bones and joints and may help your ability to perform daily activities.
- Ankylosing spondylitis (AS) in adults.
- Moderate to severe Crohn's disease (CD) and to achieve and maintain clinical remission in adults who have not responded well to conventional treatments. HUMIRA is also for these adults who have lost response to or are unable to tolerate infliximab.
In adults, to help get moderate to severe ulcerative colitis (UC) under control (induce remission) and keep it under control (sustain remission) when certain other medicines have not worked well enough. It is not known if HUMIRA is effective in people who stopped responding to or could not tolerate anti-TNF medicines.
To treat moderate to severe chronic plaque psoriasis (Ps) in adults who are ready for systemic therapy or phototherapy, and are under the care of a doctor who will decide if other systemic therapies are less appropriate.

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You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

If you cannot afford your medication, contact: www.pparx.org or call the toll-free phone number (1-888-4PPA-NOW) for assistance.