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Ulcerative colitis is an immunologically mediated inflammation of the colon and rectum. The cause is not known. It is associated with an increased risk of colon cancer. It often appears between the ages of 15 and 30, but it can be seen at any age.
Typical symptoms of ulcerative colitis include rectal bleeding, bloody diarrhea, abdominal cramps, pus, and abdominal pain. The symptoms vary in severity. Other symptoms can include perforation of the colon, “toxic megacolon” with bacterial sepsis, inflammation of the eyes (iritis,  uveitis), erythema nodosum and pyoderma gangrenosum skin lesions, inflammatory arthritis, back pain and stiffness (sacroiliitis), blood clots, liver disease (primary sclerosing cholangitis), weight loss, anemia, and fatigue.
Some patients with ulcerative colitis can have mild and intermittent symptoms, while other patients are completely disabled.
While we know that ulcerative colitis involves the immune system and how it interacts with the bacteria and viruses in your colon, it is not known exactly how that interaction occurs and what triggers the inflammation that then leads to ulceration of the inner lining (mucosa) of the colon and rectal areas.
The diagnosis of ulcerative colitis is typically made by a gastroenterologist who performs a colonoscopy and a biopsy of the colon.
Ulcerative colitis must be distinguished from Crohn's Disease, which can also involve the colon. However, the inflammation that is seen in ulcerative colitis is confined to the mucosa, while the inflammation in Crohn's Disease involves the entire thickness of the intestinal wall. Also, Crohn's Disease, while it may affect only the colon, usually affects other parts of the gastrointestinal tract (including the small intestine). Ulcerative colitis affects only the colon and rectum.
Both ulcerative colitis and Crohn's Disease can cause a type of arthritis referred to as “spondyloarthropathy.” This is an inflammatory arthritis that involves not only the peripheral joints in the body, such as the hands, shoulders, hips, knees, and feet, but also the sacroiliac joints and the spine.
Symptoms typically include joint pain and stiffness, swelling and tenderness of involved joints, and back pain and stiffness. The back pain is often at its worst in the mornings and at nighttime.
In many patients, the HLA-B27 antigen blood test is positive in patients who have ulcerative colitis or Crohn's Disease. This is a genetic test that identifies a “disease susceptibility” gene, meaning that if you are born with a positive HLA-B27 antigen, then you will be at increased risk of developing a spondyloarthropathy (such as ankylosing spondylitis) in your lifetime.
Medications for ulcerative colitis include aminosalicylates (or “5-ASAs”) that help control inflammation. These include mesalamine (Asacol, Pentasa, and Rowasa) and sulfasalazine (Azulfidine). These medications are similar, but sulfasalazine has a “sulfa” group in its molecular structure, and the 5-ASA's do not.  Immunosuppressive medications, such as azathioprine (Imuran) are used, as are “biologic” drugs, such as Humira, Remicade and Simponi. They can be used alone or in conjunction with the 5-ASAs. The monoclonal antibody drug “Entyvio” targets alpha-4-beta 7 integrin and reduces inflammation in the colon.
Traditional anti-inflammatory drugs (NSAIDs) may be problematic. They are sometimes prescribed for the arthritis that goes along with ulcerative colitis, but they are capable of flaring the colitis.
Corticosteroids, such as prednisone, can be used temporarily to quiet down severe flares, but they are typically reserved only for short-term use.
Surgical treatment may be required, which in severe cases may consist of total colectomy (removal of the entire colon and rectum) and ileostomy. That may be required in “toxic megacolon” or in patients whose disease cannot be adequately controlled with medications.
A useful medical journal article on ulcerative colitis is by Lynch WD and Hsu R entitled “Ulcerative Colitis.” It was published in 2019 at https://www.ncbi.nlm.nih.gov/books/NBK459282/
The Social Security Administration's (SSA) impairment listing manual (commonly called the “Blue Book”) includes ulcerative colitis under Section 5.06 – Inflammatory Bowel Disease. Whether you qualify for Social Security Disability (SSDI) benefits will depend on your symptoms and your exertional functional capability, as determined by your treating doctor(s).
Similarly, if you are seeking benefits under a group disability plan (ERISA), your medical records, including your diagnosis, symptoms, and functional capability, will be critical to your ability to obtain long-term disability (LTD) benefits.
Under an ERISA-governed group disability plan, most policies provide that you must be initially disabled from performing the material duties of your own occupation (“own occ”). However, after the first two years, the definition of disability often changes to being unable to perform any occupation (“any occ”).
This is a point at which the definitions of “disability” under both the SSA and ERISA, while not identical, are quite similar. “Any occupational” disability (under an ERISA plan) is arguably tantamount to “less than sedentary” functional capability (under SSDI).
While courts have held that SSA disability decisions are “instructive” in ERISA cases [See: Halpin v. W.W. Grainger, Inc., 962 F. 2d 685 (7th Cir. 1992)], they have stopped short of creating an equivalence between the disability definitions under SSDI and ERISA [See: Armani v.  Northwestern Mutual Life Insurance Co., 840 F.3d 1159, 1164 (9th Cir. 2016)]. However, this is an important area of the law that continues to evolve and is worth monitoring.
At Law Med, we can help you with both your SSDI and ERISA claims.
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