Sulfasalazine for rheumatoid arthritis


Generic Name Brand Name
sulfasalazine Azulfidine, Sulfazine

Sulfasalazine is a medicine formed from salicylic acid (the active ingredient in aspirin) and an antibiotic, sulfapyridine. It is given by mouth (orally) and is available in time-release tablets.

How It Works

Sulfasalazine reduces joint inflammation associated with rheumatoid arthritis and slows or stops the disease from getting worse. It is also often used to treat inflammatory bowel disease.

Why It Is Used

Sulfasalazine is used for early, milder cases of rheumatoid arthritis. It may be used with other medicines, such as nonsteroidal anti-inflammatory drugs (NSAIDs), or with disease-modifying antirheumatic drugs (DMARDs) for more active rheumatoid arthritis.

People with sulfa or salicylate allergies should not use this medicine.

How Well It Works

Studies indicate that sulfasalazine is effective in relieving the symptoms and slowing the progression of rheumatoid arthritis. Although sulfasalazine treatment may show results within 1 month, it typically takes several months to be effective.1

Side Effects

Sulfasalazine is usually well-tolerated. Side effects are usually temporary and may include:

  • Skin rash.
  • Nausea.
  • Abdominal discomfort.

Rare side effects include low blood counts and allergic reactions.1

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

What To Think About

Talk to your health professional before taking this medicine if you are pregnant or thinking about becoming pregnant. Do not take sulfasalazine if you are breast-feeding.

Sulfasalazine has been used for many years to treat rheumatoid arthritis. It is usually used to treat people with early, milder cases of rheumatoid arthritis. It is used in combination with methotrexate and hydroxychloroquine in what is sometimes referred to as triple therapy. Research continues on sulfasalazine's effectiveness in halting the progression of rheumatoid arthritis in comparison with newer DMARDs, such as leflunomide (Arava), etanercept (Enbrel), and infliximab (Remicade).

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  1. Kwoh CK, et al. (2002). Guidelines for the management of rheumatoid arthritis. Arthritis and Rheumatism, 46(2): 328–346.

Last Updated: August 18, 2008

Author: Shannon Erstad, MBA/MPH

Medical Review: Anne C. Poinier, MD - Internal Medicine & Stanford M. Shoor, MD - Rheumatology

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