S4901 Complex Case of Ulcerative Colitis and Hidradenitis Suppurativa Treated With Upadacitinib

Introduction: Ulcerative colitis (UC) and hidradenitis suppurativa (HS) are 2 chronic inflammatory diseases that can significantly impact a patient’s quality of life. Managing patients who have both conditions is challenging due to the overlapping immune pathways and the potential for 1 disease to exacerbate the other. While biologic therapies have revolutionized the treatment of both UC and HS, they may not always be effective, and their use often involves considerations beyond the medications themselves. Targeting the immune system using Janus kinase (JAK) inhibitors, such as upadacitinib, offers an approach for treating both UC and HS. Inhibiting the JAK pathway blocks signaling that contributes to the chronic inflammation seen in both conditions. JAK inhibitors can be utilized in HS and UC treatment, particularly for patients with insufficient responses, side effects, or challenges with the administration of biologics therapy. Case Description/Methods: A 40-year-old woman with a complex medical history, including UC, HS, plaque psoriasis, and rheumatoid arthritis, presented with many challenging comorbidities. The patient had a longstanding history of HS-associated anemia and was diagnosed with UC in early 2023. Initial treatment included mesalamine and prednisone, later transitioned to balsalazide. Despite some symptom control, colonoscopy findings and persistent rectal bleeding necessitated escalation to biologic therapy. Ustekinumab was initiated but discontinued due to sepsis following skin and urinary infections. After disease flare-ups and elevated fecal calprotectin levels, upadacitinib was selected for its efficacy in UC, HS, and joint symptoms. By March 2025, the patient showed significant improvement in gastrointestinal and dermatologic symptoms while on upadacitinib and balsalazide. Discussion: This case highlights the interplay between multiple chronic conditions, which require careful and coordinated management. The patient’s response to biologics, particularly ustekinumab, was limited, which led to the consideration of alternative therapies such as upadacitinib. The evolving treatment approach reflects the need for individualized care, particularly when managing comorbid autoimmune conditions. Ongoing monitoring of inflammatory markers, liver function tests, and fecal calprotectin levels remains critical in optimizing treatment strategies for patients with disease profiles like this one.