Sulfasalazine for juvenile rheumatoid arthritis


Generic Name Brand Name
sulfasalazine Azulfidine

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

How It Works

Sulfasalazine may reduce joint inflammation caused by juvenile rheumatoid arthritis (JRA).

Why It Is Used

Sulfasalazine is considered a second-line treatment for JRA. Its use is reserved for children with JRA who do not respond to nonsteroidal 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 JRA, particularly children with polyarticular JRA (polyarthritis) and pauciarticular JRA (oligoarthritis).1

Side Effects

Children with systemic JRA 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, stomachache.
  • Headache.

Uncommon side effects include:

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

It is common practice 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 JRA.

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  1. Brooks CD (2001). Sulfasalazine for the management of juvenile rheumatoid arthritis. Journal of Rheumatology, 28(4): 845–853.
  2. Giannini EH, Brunner HI (2005). Treatment of juvenile rheumatoid arthritis. In WJ Koopman, LW Moreland, eds., Arthritis and Allied Conditions, 15th ed., vol. 1, pp. 1301–1318. Philadelphia: Lippincott Williams and Wilkins.

Last Updated: June 25, 2008

Author: Shannon Erstad, MBA/MPH

Medical Review: Michael J. Sexton, MD - Pediatrics & Stanford M. Shoor, MD - Rheumatology

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