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DOES SULFASALAZINE HAVE FREQUENT SIDE EFFECTS IN ADULT-ONSET STILL'S DISEASE?

 

Ja-Hun Jung, Jae-Bum Jun, Dae-Hyun Yoo, Hee Kwan Koh, Seung Cheol Shim, Dae Kook Chang, Tae-Hwan Kim, Sung Soo Jung, In Hong Lee, Sang Cheol Bae, Seong Yoon Kim

The Hospital for Rheumatic Diseases, Department of Internal Medicine, Hanyang University College of Medicine, Seoul 133-792, Korea


Sulfasalazine (SSZ) is widely used as a second line drug in chronic arthritis such as rheumatoid arthritis (RA) and juvenile rheumatoid arthritis (JRA). In many reports, use of SSZ in children with systemic-onset JRA (Still's disease) revealed frequent side effects sufficient to require discontinuation of the drug. Besides, there was no controlled study for the efficacy and safety of SSZ in adult-onset Still's disease (AOSD) as the adult counterpart of Still's disease.


We studied whether there were frequent side effects of SSZ in AOSD. From July 1990 to April 1998, we experienced 41 patients fitting Yamaguchi's criteria for AOSD (J Rheumatol 19: 424­430, 1992). We randomly chose 109 patients with RA given SSZ as controls. 10 out of 41 patients with AOSD were given SSZ for control of arthritis. Sixteen patients (14.7%) with RA discontinued SSZ due to mild side effects such as rash, urticaria, gastrointestinal troubles, mild leukopenia, and fever. However, 6 patients (60%, p < 0.01) of AOSD experienced side effects ranging from mild ones like abdominal pain, nausea and vomiting, urticaria, and facial flushing to severe ones such as high fever (3), hypotension (1), severe myelosuppression (1), and fulminant hepatitis (1) who died of it. Fifteen patients (13.8%) of RA and remaining 4 patients (40%, p = 0.053) of AOSD stopped SSZ due to inefficacy.


We concluded that SSZ appeared to be an unsafe second line drug in AOSD. Therefore, SSZ should not be recommended until being studied further in a multi-center, placebo controlled study.


Disclosure: work reported in this abstract was supported by:
Hanyang University.

Rheumatologic disorders: other
Sulfasalazine

 

Abstract: 135
November 9, 1998
Poster Session A: RA Clinical Aspects
8:00-9:30 am, Hall B1/C



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