u/Autistic-hottie

Going to my best friend’s engagement party in the middle of an AS flare and honestly terrified. I really, really want to be there for her, but I can barely walk/stand for more than ~5 minutes right now without severe pain, limping, or feeling like my body is going to give out. I’ve had moments recently where I genuinely thought I might collapse from the pain and weakness.

The hardest part is that once people notice me grimacing or struggling to walk, the whole vibe shifts and everyone starts looking worried or uncomfortable, which makes me feel even worse. I don’t want to accidentally make the event about me or create a scene. I just want to celebrate my friend and survive the night.

I already bought flat/comfy shoes, plan to avoid alcohol completely since it’s a trigger for me, and I’m trying to pace myself as much as possible. But this is going to be several hours and I’m scared I’m overestimating what my body can handle.

How do you guys handle major social events during bad flares? Do you push through? Bring mobility aids even if you feel awkward? I worry that a cane or a walker or a wheelchair is social suicide and drags even more attention than anything else… Could I just sit most of the night? Or will that look weird??

I am trying to be realistic without completely isolating myself from life.

I’m trying to figure out what I’m missing in getting a biologic approved through UHC/Optum. I want to make sure this is being approached correctly from a documentation and criteria standpoint.

Here’s what is formally documented in my chart:

Diagnoses:
Ulcerative colitis with complications (ICD-10: K51.919)
Seronegative spondyloarthropathy (ICD-10: M47.819)
Inflammatory arthritis (ICD-10: M19.90)

Rheumatology assessment:
UC-associated spondyloarthropathy / inflammatory back pain
Axial involvement (lower back/hip) with intermittent peripheral joint involvement (knees/ankles)
Inflammatory features: nocturnal pain, morning stiffness
Disease described as active and progressive
Family hx ankylosing spondylitis (Mother)
Prior csDMARDs ineffective or not tolerated
Plan: initiate adalimumab (Humira) 40 mg every 2 weeks

Limitations in current workup: no SI joint MRI or X-ray yet

Additional context:
I have a history of ulcerative colitis, which is an FDA-approved indication for Humira
I cannot tolerate NSAIDs due to UC (so standard step therapy is not appropriate)

Insurance response (UHC/Optum): Denial stating no qualifying diagnosis. Likely also no documented NSAID failure, they still haven’t given me the official denial letter. So, I’m going off of the 3 people I spoke to on the phone.

Questions:
Is M47.819 (seronegative spondyloarthropathy) too nonspecific for approval?

Do they typically require a more defined diagnosis like ankylosing spondylitis (M45.x) or non-radiographic axial SpA?

Does lack of objective imaging (SI joint MRI/X-ray) usually result in denial?

From a strategy standpoint, is it more straightforward to pursue approval under ulcerative colitis, rather than a rheumatologic indication?

How should NSAID contraindication be documented so it satisfies step therapy requirements?

For those familiar with UHC/Optum, is this more commonly:
A coding issue?
A prior auth documentation issue?
Or just needing more objective evidence?

Next steps I’m considering:
*Requesting SI joint MRI
*Having NSAID contraindication clearly documented
*Clarifying diagnosis coding
*Possibly resubmitting under UC instead of rheumatology

I’m trying to approach this correctly and efficiently rather than going back and forth with denials… I’m in constant pain and discomfort.

I go to the bathroom 4x per hour and I’m getting so dehydrated from being unable to keep food and most drinks down that my feet cramp up and get stuck in a weird position and then I cannot walk… I’ve had to call 911 on myself more than once. My UC is very very severely flaring and my arthritis is so bad I’m walking with a cane. I can’t even do the 7 min walk to CVS anymore. I’m in sooo much pain sitting/ standing too. Everything eventually starts to hurt and I feel so depleted. I’m so sick.

My BMI is a 16.9 and my quality of life is terrible… I am worried I will lose my job soon because my performance has dropped and I missed 2 out of 4 weeks this month as I was in the hospital… and then sent home with meds I can’t take on the job legally.

I have been flaring since the middle of March. I’m sick of being sick. I cannot live like this anymore.

If anyone has specific experience with UHC/Optum approvals for biologics, I’d appreciate practical guidance on what actually works!

I’m trying to figure out what I’m missing in getting a biologic approved through UHC/Optum. I want to make sure this is being approached correctly from a documentation and criteria standpoint.

Here’s what is formally documented in my chart:

Diagnoses:
Ulcerative colitis with complications (ICD-10: K51.919)
Seronegative spondyloarthropathy (ICD-10: M47.819)
Inflammatory arthritis (ICD-10: M19.90)

Rheumatology assessment:
UC-associated spondyloarthropathy / inflammatory back pain
Axial involvement (lower back/hip) with intermittent peripheral joint involvement (knees/ankles)
Inflammatory features: nocturnal pain, morning stiffness
Disease described as active and progressive
Prior csDMARDs ineffective or not tolerated
Plan: initiate adalimumab (Humira) 40 mg every 2 weeks

Limitations in current workup: no SI joint MRI or X-ray yet

Additional context:
I have a history of ulcerative colitis, which is an FDA-approved indication for Humira
I cannot tolerate NSAIDs due to UC (so standard step therapy is not appropriate)

Insurance response (UHC/Optum): Denial stating no qualifying diagnosis. Likely also no documented NSAID failure, they still haven’t given me the official denial letter. So, I’m going off of the 3 people I spoke to on the phone.

Questions:
Is M47.819 (seronegative spondyloarthropathy) too nonspecific for approval?

Do they typically require a more defined diagnosis like ankylosing spondylitis (M45.x) or non-radiographic axial SpA?

Does lack of objective imaging (SI joint MRI/X-ray) usually result in denial?

From a strategy standpoint, is it more straightforward to pursue approval under ulcerative colitis, rather than a rheumatologic indication?

How should NSAID contraindication be documented so it satisfies step therapy requirements?

For those familiar with UHC/Optum, is this more commonly:
A coding issue?
A prior auth documentation issue?
Or just needing more objective evidence?

Next steps I’m considering:
*Requesting SI joint MRI
*Having NSAID contraindication clearly documented
*Clarifying diagnosis coding
*Possibly resubmitting under UC instead of rheumatology

I’m trying to approach this correctly and efficiently rather than going back and forth with denials… I’m in constant pain and discomfort. If anyone has specific experience with UHC/Optum approvals for biologics, I’d appreciate practical guidance on what actually works.