Sulfasalazine is an established Disease Modifying Anti Rheumatic Drug (DMARD) with proven efficacy in many kinds of Arthritides. It can be used in Rheumatoid arthritis s well as spondyloarthropathy. Comparatively It has a better safety Margin than other drugs such as Methotrexate and leflunomide. Sulfasalazine is one of the very few drugs which can even be used in pregnancy. You are aware that most drugs are unsafe for the foetus in pregnancy but this one can be used upto 2 weeks before the expected date of delivery. It needs to be stopped during breast feeding. Hence in young women with arthritis planning to get married or recently married women planning to conceive we use sulfasalazine. It is safer than other anti rheumatic drugs such as methotrexate etc from the liver or Kidney point of view as well. However This drug contains a sulpha molecule and hence Patients with allergy to sulpha cannot not be given this drug. A blood test to look for G6PD deficiency should first be done before starting this medication. It’s action is usually discernible in 8 weeks. The usual dose is 50 mg/kg/day in divided doses upto a maximum of 3000 mg per day If given in full dose at onset, it can give rise to nausea and vomiting. Hence it is advisable to start with a small dose with weekly/fortnightly increments till the optimum or maximum dose is reached. The drug should be given after food only so as to minimize chance of intolerance. The main side-effects are gastric intolerance and Skin rash. Sometimes mouth Ulcers can also occur. Additionally a few patients can develop Photosensitivity which means that skin rash and itching can occur on sun exposure. Anaemia secondary to destruction of red blood cells is seen at times and hence periodic blood tests are mandatory every 4 to 8 weekly as advised by your attending doctor A Reversible drop in sperm count can occur. Hence, in young males this drug should only be started after giving due consideration of their plans to conceive in the near future. Sometimes it may be wiser to check a baseline semen examination and make sure that the count is adequate. Very rarely a hypersensitivity phenomenon may be noted affecting the Lungs which would present as Dry cough and breathlessness. It may be advisable to take folic acid supplements along with Sulfasalazine.
Symptoms to watch for & report
- Oral ulcers
- Abnormal blood tests – report immediately
- Persistent (> 4-5 days) cough and breathlessness – report immediately
- Any other significant symptom