Sulfasalazine for juvenile idiopathic arthritis

Examples

Generic Name	Brand Name
sulfasalazine	Salazopyrin

Sulfasalazine is a combination of salicylic acid (the active ingredient in ASA) and an antibiotic, sulfapyridine.

How It Works

Sulfasalazine may reduce joint inflammation caused by juvenile idiopathic arthritis (JIA).

Why It Is Used

Sulfasalazine is considered a second-line treatment for JIA. Its use is reserved for children with JIA who do not respond to non-steroidal anti-inflammatory drugs (NSAIDs) or methotrexate. Children who are allergic to sulfa medicines or salicylates cannot use this medicine.

How Well It Works

Some data indicate that the use of sulfasalazine is effective in the treatment of JIA, particularly children with polyarticular JIA (polyarthritis) and pauciarticular JIA (oligoarthritis).¹

Side Effects

Children with systemic JIA are most likely to experience severe side effects and therefore are not treated with sulfasalazine.²

Common but not serious side effects may include:

• Nausea, gas, diarrhea or loose stools, stomach ache.
• Headache.

Uncommon side effects include:

• Severe allergic reactions, rashes.
• Lowered blood counts.
• Liver inflammation.
• Severe mouth sores and blisters.

It is common practise to do a complete blood count (CBC) every 6 to 12 months when using sulfasalazine.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

Positive effects from sulfasalazine treatment can take 1 to 3 months to become apparent, which is faster than some other second-line medicines.²

Sulfasalazine is considered safer, but is generally less effective, than methotrexate. A child who cannot take or hasn't responded to first-line NSAID treatment or to methotrexate may be given sulfasalazine.

Sulfasalazine can cause severe side effects in children with systemic JIA.

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Author:	Douglas Dana Shannon Erstad, MBA/MPH	Last Updated: August 30, 2006
Medical Review:	Adam Husney, MD - Family Medicine Michael J. Sexton, MD - Pediatrics Ross E. Petty, MD, PhD, FRCPC - Pediatric Rheumatology
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