Sulfasalazine

Disease Modifying Antirheumatic Drugs (DMARD): A disease-modifying antirheumatic drug (DMARD) that is often the first DMARD to be used because it is relarively well tolerated. It suppresses disease activity and helps to reduce active inflammation in the joint lining (synovium). Note that it is not an analgesic (i.e. it does not influence pain pathways) but reduces pain indirectly by the above mechanisms. Like other DMARDs it takes many weeks before its maximum effect is achieved.

IBD (Inflam bowel disease): It suppresses disease activity and helps to reduce active inflammation in the colon. Note that it is not an analgesic (i.e. it does not influence pain pathways) but reduces pain indirectly by the above mechanisms.

Disease Modifying Antirheumatic Drugs (DMARD): Commonly skin rashes and GI upset. Importantly, reduction in WBCs (neutrophils) and platelets which necessitates careful monitoring of full blood counts during treatment. Reversible azoospermia, anaphylaxis, photosensitivity, and a tendency to reduce folate levels (folic acid supplements sometimes given). Patients receiving aminosalicylates should be advised to report any unexplained bleeding, bruising, purpura, sore throat, fever or malaise that occurs during treatment. A blood count should be performed and the drug stopped immediately if there is suspicion of a blood dyscrasia.

IBD (Inflam bowel disease): Commonly skin rashes and GI upset. Importantly, reduction in WBCs (neutrophils) and platelets which necessitates careful monitoring of full blood counts during treatment. Reversible azoospermia, anaphylaxis, photosensitivity, and a tendency to reduce folate levels (folic acid supplements sometimes given). Patients receiving aminosalicylates should be advised to report any unexplained bleeding, bruising, purpura, sore throat, fever or malaise that occurs during treatment. A blood count should be performed and the drug stopped immediately if there is suspicion of a blood dyscrasia. See eBNF.

Disease Modifying Antirheumatic Drugs (DMARD): See BNF.

IBD (Inflam bowel disease): By mouth as enteric-coated tablets. See BNF.

Disease Modifying Antirheumatic Drugs (DMARD): See BNF.

IBD (Inflam bowel disease): See eBNF.

Disease Modifying Antirheumatic Drugs (DMARD): Sulfasalasine is often the initial DMARD to be used but other long-established initial DMARDS that might be tried include penecillamine, gold and hydroxychloroquine (an anti-malarial drug) - see below. DMARDs are not analgesics but target the immune-mediated inflammatory activity. DMARDs do not produce an immediate therapeutic effect and may require require 4-6 months to achieve their maximum effect. Assessment of response is based on clinical features such as joint inflammatory activity (synovitis) and pain or disability scores and also on investigations such as markers of inflammation (ESR, CRP), anaemia, and immunological tests eg.rheumatoid factor (an IgM Ab against host IgG) titre. A good response should allow NSAID dose to be reduced. If there is no objective benefit to one DMARD it is discontinued and another is tried. Some DMARDs may retard erosive damage as judged radiologically. Other initial DMARDs: Gold (sodium aurothiomalate/auranofin). Given by intramuscular injection weekly (also oral which is less effective but has less side-effects). Adverse effects include mouth ulcers, rashes, bone marrow suppression and proteinuria. For that reason it is necessary to monitor blood count and urine during treatment. Penicillamine (dimethylcysteine). Ad metabolite of penicillin that is also used as a chelating agent for lead. Adverse effects include taste disturbance (Zn chelation), bone marrow suppression and proteinuria. For that reason it is necessary to monitor blood count and urine during treatment. Hydroxychloroquine. Also used for systemic lupus erythematosis (SLE) and malaria. Major adverse effect is retinal damage causing blurred vision and decreased acuity – eye tests should be monitored.

IBD (Inflam bowel disease): Also used as an initial DMARD for treating rheumatoid arthritis.