High toxicity of sulfasalazine in adult-onset Still's disease

Objective Sulfasalazine (SSZ) is an anti-rheumatic drug that has been used to tr eaf chronic arthritis. In many reports, the use of SSZ in children with systemi c onset juvenile rheumatoid arthritis (JRA) revealed frequent side effects which required discontinuation of the drug. We examined whether there were frequent side effects of SSZ in patients with adult-onset Still's Disease ( AOSD). Methods From July 1990 to April 1998 we followed 41 AOSD patients. Ten were given S SZ for the treatment of arthritis and the side effects were studied. We als o studied 109 consecutive patients with RA who had been given SSZ, as a con trol group. In addition, we retrospectively studied the side effects and ef ficacy of SSZ in both groups through their medical records. Results Six patients (60%, p < 0.01) with AOSD experienced side effects ranging fro m mild ones like abdominal pain, nausea and vomiting, urticaria, and facial flushing to severe ones such as high fever hypotension, and severe myelosu ppression as well as fulminant hepatitis, which led to the death of one pat ient. However 16 patients (14.7%) with RA stopped using SSZ due to mild sid e effects such as rash, urticaria, gastrointestinal troubles, mild leukopen ia, and fever. Three AOSD patients (30%, p = 0.053) and 15 RA patients (13. 8%) stopped using SSZ due to its inefficacy. Conclusion We conclude that SSZ appears to have frequent severe side effects in AOSD, as in systemic onset JRA. These potential adverse effects of SSZ should be considered when it is used to treat chronic arthritides with systemic sympt oms. Further study of SSZ in the treatment of AOSD in a multi-center, place bo-controlled environment is needed.