ab1802

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

J.H. Jung¹, J.B. Jun², D.H. Yoo², T.H. Kim², S.S. Jung², I.H. Lee², S.C. Bae², S.Y. Kim²

¹Department of Internal Medicine, Eulji Medical College Hospital, Taejon;² Hospital for Rheumatic Diseases, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea.

ABSTRACT
Objective
Sulfasalazine (SSZ) is an anti-rheumatic drug that has been used to treat chronic arthritis. In many reports, the use of SSZ in children with systemic 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 SSZ for the treatment of arthritis and the side effects were studied. We also studied 109 consecutive patients with RA who had been given SSZ, as a control group. In addition, we retrospectively studied the side effects and efficacy of SSZ in both groups through their medical records.

Results
Six patients (60%, p < 0.01) with AOSD experienced side effects ranging from mild ones like abdominal pain, nausea and vomiting, urticaria, and facial flushing to severe ones such as high fever, hypotension, and severe myelosuppression as well as fulminant hepatitis, which led to the death of one patient. However, 16 patients (14.7%) with RA stopped using SSZ due to mild side effects such as rash, urticaria, gastrointestinal troubles, mild leukopenia, 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 symptoms. Further study of SSZ in the treatment of AOSD in a multi-center, placebo-controlled environment is needed.

Key words
Adult-onset Still's disease, sulfasalazine.

Please address correspondence and reprint requests to: Jae-Bum Jun, MD, PhD, The Hospital for Rheumatic Diseases, Department of Internal Medicine, Hanyang University College of Medicine, 17 Haengdang-dong, Sungdong-gu, Seoul 133-792, Korea.
E-mail: junjb@email.hanyang.ac.kr