Sulfasalazine (brand name: Azulfidine) is an effective DMARD that is used in the treatment of RA. This drug is created from the combination of salicylic acid (the active ingredient in aspirin) and sulfapyridine (an antibiotic). It is given by mouth and is available in the form of time-release tablets. Like the other DMARDs, sulfasalazine has been shown not only to reduce the signs and symptoms of RA, but also to slow or halt joint destruction.
Rheumatologists are unsure of how this medication works to improve symptoms, but studies have demonstrated that more than half of all patients treated with sulfasalazine have improvements in their pain symptoms. Like the other DMARDs, sulfasalazine may take several months before it helps to reduce the pain and swelling of RA. Rheumatologists reserve sulfasalazine for use in early, milder cases of RA or as an alternative to methotrexate in patients with liver disease. The usual dose is 2 to 3 grams per day, with pills being taken twice daily.
Sulfasalazine may be used in combination therapy with NSAIDs and other DMARDs for more active RA. Because this drug is a combination of aspirin and a sulfur-containing antibiotic, people with sulfa or aspirin allergies should not use it.
Sulfasalazine can cause side effects that are severe enough to stop treatment in as many as 22% of patients. The most common side effects include allergic reactions, stomach upset, skin rashes, abnormal blood cell counts, and liver problems. To monitor for these problems, tests of liver function and blood cell counts should be performed every one to three months depending on dose.