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Sulfasalazine

Sulfasalazine is a disease modifying anti-rheumatic drug (DMARDs) used in the management of inflammatory arthritis, especially rheumatoid arthritis. It is also used in the management of inflammatory bowel disease.

Sulfasalazine is a prodrug for 5-ASA which works through decreasing neutrophil chemotaxis alongside suppressing proliferation of lymphocytes and pro-inflammatory cytokines.

Cautions

  • G6PD deficiency
  • allergy to aspirin or sulphonamides (cross-sensitivity)

Adverse effects

  • oligospermia
  • Stevens-Johnson syndrome
  • pneumonitis / lung fibrosis
  • myelosuppression, Heinz body anaemia, megaloblastic anaemia
  • may colour tears → stained contact lenses

In contrast to other DMARDs, sulfasalazine is considered safe to use in both pregnancy and breastfeeding.