Sock it to arthritis with sulfasalazineSulfasalazine is a drug that combines 5-aminosalicylic acid (5-ASA) plus sulfapyridine. While the mechanism of action is unknown, it appears to interfere with a number of inflammatory pathways. Sulfasalazine seems to have significant effects in slowing down the rate of damage in rheumatoid arthritis; it also has many potential side effects. It is contraindicated in patients who are allergic to sulfa drugs or aspirin. Side effects include rashes, nausea, liver enzyme abnormalities, gastrointestinal side-effects, central nervous system problems, and drops in white blood cell count, aplastic anemia, Stevens-Johnson syndrome (a life-threatening skin condition), and orange discoloration of the urine. Drug interactions with warfarin and methotrexate may occur. Patients who have a condition called glucose-6 phosphate dehydrogenase deficiency may have a higher incidence of blood problems. Drops in sperm count may also occur. Gastrointestinal symptoms tend to occur early in the course of treatment. Starting at a low dose and gradually increasing the dose is recommended. The enteric coated tablets may be better tolerated. Folate deficiency may occur. Supplemental folic acid is recommended. Patients with kidney problems need to watched particularly carefully. Careful monitoring during the first six months of therapy is needed.
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