Understanding Pediatric Ulcerative Colitis (PUC)
Your child looks to you for comfort and guidance
When it comes to ulcerative colitis, you may not know what to do. PUC symptoms are unpredictable and may keep your child from participating in activities he or she enjoys.
You’ve both learned to cope with the unexpected flare-ups. You’d give just about anything to help relieve your child’s symptoms and help him or her do more of the things kids like to do. You wonder what the future holds.
If your child is still experiencing unpredictable flare-ups and other PUC symptoms, talk to your child’s doctor. Help may be within reach.
What is PUC?
PUC is a condition that occurs in children younger than 17 years of age and causes inflammation in the colon or large intestine. It is among the most common gastrointestinal conditions managed by gastroenterologists in the United States.
Symptoms of PUC include blood in the stool or bloody diarrhea, frequent bowel movements, rectal bleeding, stomach pain, cramping, joint pain, fatigue, and weight loss.
What causes PUC?
The direct cause of PUC is unknown. But we do know that children may be more likely to experience it if ulcerative colitis is part of their family’s medical history.
PUC symptoms begin when the immune system attacks healthy cells in a child’s body, for reasons we do not yet understand. Normally, the immune system (the body’s natural defense system) protects the body from bacteria, viruses, and other foreign agents. When children have PUC, their immune system incorrectly targets their gastrointestinal tract. This causes inflammation, leading to the symptoms and flares usually experienced with PUC.
Who gets PUC?
PUC is usually seen in adolescents, but younger children also have been seen with the disease.
Are the symptoms of PUC interfering with your child’s life?
Symptoms of PUC can be mild, moderate, or severe and may develop over time or very suddenly.
Symptoms typically include:
- Stomach pain
- Weight loss
- Joint pain
These symptoms can interrupt your child’s daily routine. If your son or daughter is taking medication and is still experiencing symptoms, his or her symptoms aren’t really under control. While you and your child may have learned to live with your current treatment, you may not have to anymore—there are more options available.
Only your doctor can recommend a course of treatment after checking your health condition. REMICADE® (infliximab) can cause serious side effects such as lowering your ability to fight infections. Some patients, especially those 65 years and older, have had serious infections caused by viruses, fungi or bacteria that have spread throughout the body, including tuberculosis (TB) and histoplasmosis. Some of these infections have been fatal. Your doctor should monitor you closely for signs and symptoms of TB during treatment with REMICADE®.
Unusual cancers have been reported in children and teenage patients taking TNF-blocker medicines. Hepatosplenic T-cell lymphoma, a rare form of fatal lymphoma, has occurred mostly in teenage or young adult males with Crohn’s disease or ulcerative colitis who were taking REMICADE® and azathioprine or 6-mercaptopurine. For children and adults taking TNF blockers, including REMICADE®, the chances of getting lymphoma or other cancers may increase.
You should discuss any concerns about your health and medical care with your doctor.
What should I tell my doctor before I take REMICADE®?
You should let your doctor know if you have or ever had any of the following:
- Tuberculosis (TB) or have been near someone who has TB. Your doctor will check you for TB with a skin test. If you have latent (inactive) TB, you will begin TB treatment before you start REMICADE®.
- Lived in a region where certain fungal infections like histoplasmosis or coccidioidomycosis are common.
- Infections that keep coming back, have diabetes or an immune system problem.
- Any type of cancer or a risk factor for developing cancer, for example, chronic obstructive pulmonary disease (COPD) or had phototherapy for psoriasis.
- Heart failure or any heart condition. Many people with heart failure should not take REMICADE®.
- Hepatitis B virus (HBV) infection or think you may be a carrier of HBV. Your doctor will test you for HBV.
- Nervous system disorders (like multiple sclerosis or Guillain-Barré syndrome).
Also tell your doctor if you:
- Use the medicines Kineret (anakinra), Orencia (abatacept) or Actemra (tocilizumab) or other medicines called biologics used to treat the same problems as REMICADE®.
- Are pregnant, plan to become pregnant, are breast-feeding, or have a baby and were using REMICADE® during your pregnancy. Tell your baby’s doctor about your REMICADE® use before the baby receives any vaccine because of an increased risk of infection for up to 6 months after your last dose of REMICADE® you received during your pregnancy.
- Recently received or are scheduled to receive a vaccine. Adults and children taking REMICADE® should not receive live vaccines or treatment with a weakened bacteria (such as BCG for bladder cancer) while taking REMICADE®.
What should I watch for and talk to my doctor about before or while taking REMICADE®?
The following serious (sometimes fatal) side effects have been reported in people taking REMICADE®.
You should tell your doctor right away if you have any of the signs listed below:
- Infections (like TB, blood infections, pneumonia)—fever, tiredness, cough, flu, or warm, red or painful skin or any open sores. REMICADE® can make you more likely to get an infection or make any infection that you have worse.
- Lymphoma, or any other cancers in adults and children.
- Skin cancer—any changes in or growths on your skin.
- Heart failure—new or worsening symptoms, such as shortness of breath, swelling of your ankles or feet, or sudden weight gain.
- Reactivation of HBV—feeling unwell, poor appetite, tiredness, fever, skin rash and/or joint pain.
- Liver injury—jaundice (yellow skin and eyes), dark brown urine, right-sided abdominal pain, fever, or severe tiredness.
- Blood disorders—fever that doesn’t go away, bruising, bleeding or severe paleness.
- Nervous system disorders—numbness, weakness, tingling, changes in your vision or seizures.
- Allergic reactions during or after the infusion—hives, difficulty breathing, chest pain, high or low blood pressure, swelling of face and hands, and fever or chills.
- Lupus-like syndrome—chest discomfort or pain that does not go away, shortness of breath, joint pain, rash on the cheeks or arms that gets worse in the sun. The more common side effects with REMICADE® are respiratory infections (that may include sinus infections and sore throat), headache, rash, coughing and stomach pain.
- Psoriasis—new or worsening psoriasis such as red scaly patches or raised bumps on the skin that are filled with pus.
Please read the accompanying Medication Guide for REMICADE® and talk with your doctor. 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.