Ulcerative colitis, which is the most common type of inflammatory
bowel disease, is a condition of episodic inflammation of the lining, or
mucosa, of the colon, resulting in bloody diarrhea. The other type of
inflammatory bowel disease is Crohn’s disease.
The cause of ulcerative colitis is unknown, but both environmental
and genetic factors are thought to have a role. The condition is more
common in North America and Northern Europe than in other parts of the
world. The risk of ulcerative colitis is increased if there is a family
history of inflammatory bowel disease.
Ulcerative colitis is less common in smokers and smokers who have
ulcerative colitis tend to have mild disease. Having had an appendectomy
at a young age decreases the risk of developing ulcerative colitis.
The inflammation in ulcerative colitis is felt to possibly be due to an
immune response against the bacteria that normally live in the colon.
The inflammation usually starts at the rectum, which is the end of the
colon, and it can extend in a continuous manner to involve more areas
and possibly the entire colon.
If the inflammation of ulcerative colitis only involves the rectum it
is called ulcerative proctitis . If the rectum and the adjacent area,
which is known as the sigmoid colon, are involved, it is called
proctosigmoiditis. If the inflammation is more extensive but still
limited to the left side of the colon that is known as left-sided
colitis. Involvement of more than the left side of the colon is referred
to as pancolitis.
It is possible that over time the inflammation may spread to areas of
the colon that were not involved at the time of diagnosis. Ulcerative
colitis does not affect the small intestine, except for occasional
involvement of the ileum, which is located adjacent to the colon.
Besides bloody diarrhea, attacks of ulcerative colitis might cause
abdominal pain, weight loss, anemia, passage of mucus, and fever. Most
people will have periods of relapse and remission. In addition,
ulcerative colitis may have manifestations outside of the colon,
possibly causing arthritis, skin and mouth lesions, inflammation of the
eyes, and liver disease.
A number of medications may be used in the treatment of ulcerative
colitis. The aminosalicylates, which include mesalamine, olsalazine,
sulfasalazine, and balsalazide, are often the medication of choice both
to achieve and to maintain remission.
Glucocorticoids may be used to achieve remission when
aminosalicylates are not adequate, but are not effective in the
maintenance of remission. The immunosuppressive agents azathioprine or
6-mercaptopurine might be prescribed in order to avoid the use of
glucocorticoids, which can cause a number of serious side effects,
including elevated glucose, osteoporosis, thinning of the skin, weight
gain, cataracts, and several others.
Other medications that might be used in serious cases of ulcerative
colitis include the immunosuppressive agents cyclosporine and
tacrolimus, and the biologic agents, such as infliximab and adalimumab.
Up to about 30 percent of people with ulcerative colitis will
ultimately require surgery, either due to failure of medical treatment
or to complications. Removal of the entire colon (total colectomy) can
cure the colonic manifestations of ulcerative colitis. However, total
colectomy may not affect the risk or severity of ulcerative colitis
associated liver disease.
People with ulcerative colitis have an increased risk of colorectal
cancer beginning about eight years after diagnosis, and thus periodic
colonoscopy with biopsies to look for dysplasia or cancer is important.
The cancer risk is related to the duration of disease and the extent of
the colon involvement.
Underwriting Ulcerative Colitis
The underwriter considers a number of factors when evaluating
applicants with ulcerative colitis, including current status, the extent
of colon involvement, time since diagnosis, treatments prescribed,
complications, and results of colonoscopy.
Applicant 1 was diagnosed with ulcerative colitis
five years ago, with disease limited to the proctosigmoid area. No
treatment has been necessary for the past three years, and a recent
colonoscopy was normal. This case can be Standard Plus.
Applicant 2 has had pancolitis for fifteen years
with associated arthritis, is taking azathioprine, and recently had a
benign colonoscopy with biopsies. This case can be Table Three off of a
Standard Plus base rate.
Applicant 3 has had ulcerative colitis for ten
years. A recent colonoscopy showed three areas of dysplasia. Complete
removal of the colon has been recommended, which the applicant is
considering. The dysplasia is premalignant and no offer can be made at
this time. If the colon is removed reconsideration can be given based
upon review of the pathology report. This case is a decline.
Rheumatoid arthritis is an autoimmune disease of unknown cause that
results in chronic systemic inflammation affecting many parts of the
body, but primarily the joints. The clinical course is highly variable.
The disease can fluctuate and may sometimes go into remission for months
or years, either spontaneously or with the use of various medications.
After 10 years, about 20% of those affected will have no disability or
joint deformities. Most however experience a progressive course with
exacerbations and remissions associated with some loss of functioning.
About 5-15% of affected individuals will have persistent disease
activity throughout the course of this illness.
The disease process causes inflammation of the capsule around the
joints, eventually leading in some cases to destruction of articular
cartillage and fusion of the joints. While it usually involves smaller
joints on both sides of the body, resulting in painful swelling and
stiffness, it can also affect the larger joints. Likewise, in about
15-25% of cases the diffuse inflammation can involve the lungs, heart,
kidneys, eyes, skin, nerves and blood vessels. About 1% of the
population has rheumatoid arthritis, and women are two to three times
more likely to have the disease than men. The onset can occur at any
age, but it usually presents between the ages of 25 and 50. Rheumatoid
arthritis becomes more prevalent at older ages.
Diagnosis & Treatments
Diagnosis is clinical and based on symptoms, physical exam, X-rays
and serologic testing. There is no cure for rheumatoid arthritis, but
many different treatments can improve symptoms and slow progression of
the disease. Disease-modifying anti-rheumatic drugs (DMARDs) are the
primary treatment. Started early in the course of the disease, these
drugs produce remissions in about 50% of individuals. They generally
improve symptoms, decrease joint damage and improve overall functional
Examples include methotrexate, sulfasalazine, leflunomide and
hydroxychloroquine. Biologic agents may be part of the regimen. Examples
include TNF blockers, interleukin 1 blockers and monoclonal antibodies.
Non-steroidal anti-inflammatory agents can relieve symptoms but do not
impact the course of the disease. Steroids can provide short term
relief, but are generally avoided for long term use due to side effects.
Rheumatoid arthritis can reduce expectation of life by approximately 3
to 12 years. Higher mortality risk is associated with a younger age at
onset, a longer duration of disease, concurrent presence of other health
problems, and characteristics of more severe and progressive disease.
The most common causes of death are cardiovascular disease, cancer and
infection. Again, the underlying unifying pathology is generalized
severe ongoing inflammation. Some of the more effective treatments for
this disease may also have serious side-effects that contribute to its
A 62 year old woman who was diagnosed with rheumatoid arthritis about 10
years ago. She is currently working full-time and plays golf once a
week. She has occasional joint discomfort that responds to ibuprofen,
and has required no other treatment. This can be Standard Plus.
A 55 year old year old woman who has had rhematoid arthritis for several
years. She is active in her community and participates in several
volunteer organizations. She is limited by occasional diffuse joint pain
and stiffness that have improved considerably with the use of
methotrexate and a biologic agent. This can be Table 2.
A 58 year old man who has been unable to work for the past three years
due to severely deformed joints resulting from rheumatoid arthritis that
began in his early 20s. He has undergone several joint replacements as
well as cervical spine surgery for instability due to rheumatic
involvement. He has recently experienced increasing shortness of breath,
and his physician has been unable to determine whether his lungs have
been affected by rheumatoid arthritis, its treatment with methotrexate,
or perhaps both. This would be a decline.
At The BIG I Conference last week we met with many of our new and
existing Independent Agency Partners. Our drawing was for a $100
donation, in the name of the winner, to Team Thompson’s No-Shave
November Fund-raiser to benefit the Battle Against Cancer.
promised, the winner was drawn today, and the winner is Carmen
MacArthur, Insurance Service Rep at the HAI Group in Cheshire, CT.
Congratulations, Carmen, and thanks to all of you who visited our booth expressing support for us and our efforts in championing this amazing cause.
We're reminding our P&C Partners (of which there are many) that we are here to help them grow their businesses and retention rates.
SVP - Business
We do this with customized automated marketing campaigns on behalf of our P&C Partners, offering additional coverages to your Personal Lines clients.
Rounding your accounts can do wonders for retention and revenues.
Life Insurance is the main thrust of these campaigns because that's what we do, but also because most Personal Lines clients don't know you offer it... and because Life Insurance represents less than 2% of revenues for Independent Agencies. So we help you tell your existing customers you can do it and how to go about it.
Up-selling existing customers is the most efficient way to grow. They already know and trust you with their protection needs.
We are leading the way in coaching Independent Agencies in developing alternative revenue streams by leveraging existing client relationships. If you're interested in boosting your retention, and bottom line let's get together and make a plan to make it happen.
Take the next step >> P.S. You wouldn't go to the store for apples if you have an orchard in your back yard.