Efficacy of Sulfasalazine?

Question

Hi, I’m 19 and I was diagnosed with RA in November last year. Before I was diagnosed I was put on 20mg prednisolone, etoricoxib 90mg and co-codemol. Once diagnosed I was put on methotrexate and folic acid, with the aim of incresing the MTX up to 20mg and decreasing the pred. I was taken off MTX in January due to a chronic cough and little response, and put on sulfasalazine 2g. Since then I have been trying to decrease the pred. I am now on 9mg daily. Every time I decrease the dose of pred I have a flare which lasts for about a week. Does the fact that I am flaring as I decrease the pred mean that the sulfasalazine is not sufficiently controlling the disease? I have now been on sulfasalazine for four and half months.

Answer

Many DMARD options are avaialble to treat RA including methotrexate, Arava (leflunomide), sulfasalazine, and biological agents.  Many of these medications require time to work (which can be several months) and require dose titration to find the efffective dose.  It is Important to communicate your symptoms to your rheumatologist and telling them that you are still having these symptoms.  Sometimes even higher doses of sulfasalazine are required to control symptoms.  Other medication options may also be needed either alone or in combination with the sulfasalazine.

Clifton Bingham, III, MD

About Clifton Bingham, III, MD

Associate Professor of Medicine
Director - Johns Hopkins Arthritis Center