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Sulfasalazine for Juvenile Idiopathic Arthritis

Examples

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 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 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 research shows that the use of sulfasalazine is effective in the treatment of JIA, particularly children with polyarticular JIA and oligoarticular JIA.1

Side Effects

All medicines have side effects. But many people don't feel the side effects, or they are able to deal with them. Ask your pharmacist about the side effects of each medicine your child takes. Side effects are also listed in the information that comes with the medicine.

Here are some important things to think about:

  • Usually the benefits of the medicine are more important than any minor side effects.
  • Side effects may go away after your child takes the medicine for a while.
  • If side effects still bother your child and you wonder if he or she should keep taking the medicine, call your doctor. He or she may be able to lower the dose or change the medicine. Do not suddenly quit taking your medicine unless your doctor tells you to.

Call 911 or other emergency services right away if your child has:

  • Trouble breathing.
  • Swelling of your face, lips, tongue, or throat.

Call your doctor right away if your child has:

  • Hives.
  • Aching joints.
  • A continuing headache.
  • Itching or a rash.

Common side effects of this medicine include:

  • Skin sensitivity to sunlight.
  • Stomach pain, nausea, loss of appetite.
  • Diarrhea.

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

What To Think About

Children with systemic JIA are most likely to experience severe side effects, so they are not treated with sulfasalazine.2

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 can't take or hasn't responded to first-line NSAID treatment or to methotrexate may be given sulfasalazine.

Your doctor may recommend a complete blood count (CBC) every 6 to 12 months when using sulfasalazine.

Your child may be sensitive to sunlight while taking sulfasalazine. Have your child use sunscreen and wear sunglasses.

Taking medicine

Medicine is one of the many tools your doctor has to treat a health problem. If your child takes medicine as your doctor suggests, it will improve your child's health and may prevent future problems. If your child doesn't take the medicines properly, his or her health (and perhaps life) may be at risk.

There are many reasons why people have trouble taking their medicine. But in most cases, there is something you can do. For suggestions on how to work around common problems, see the topic Taking Medicines as Prescribed.

Checkups

Follow-up care is a key part of your child's treatment and safety. Be sure to make and go to all appointments, and call your doctor if your child is having problems. It's also a good idea to know your child's test results and keep a list of the medicines your child takes.

Complete the new medication information form (PDF)(What is a PDF document?) to help you understand this medication.

References

Citations

  1. Hashkes PJ, Laxer RM (2005). Medical treatment of juvenile ideopathic arthritis. JAMA, 294(13): 1671–1684.
  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.

Credits

By Healthwise Staff
Primary Medical Reviewer Susan C. Kim, MD - Pediatrics
Specialist Medical Reviewer John Pope, MD - Pediatrics
Last Revised June 5, 2012

Last Revised: June 5, 2012

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