title: High toxicity of sulfasalazine in adult-onset Still's disease.
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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Internal Medicine, Eulji Medical College Hospital, Taejon, Korea.
authors.forename: J H
authors.initials: JH
authors.lastname: Jung
authors.forename: J B
authors.initials: JB
authors.lastname: Jun
authors.forename: D H
authors.initials: DH
authors.lastname: Yoo
authors.forename: T H
authors.initials: TH
authors.lastname: Kim
authors.forename: S S
authors.initials: SS
authors.lastname: Jung
authors.forename: I H
authors.initials: IH
authors.lastname: Lee
authors.forename: S C
authors.initials: SC
authors.lastname: Bae
authors.forename: S Y
authors.initials: SY
authors.lastname: Kim
mesh_terms: D015746:Abdominal Pain / Q000139:chemically induced; D000293:Adolescent; D000328:Adult; D018501:Antirheumatic Agents / Q000009:adverse effects*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy; D004342:Drug Hypersensitivity / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009325:Nausea / Q000139:chemically induced; D011446:Prospective Studies; D012189:Retrospective Studies; D016706:Still's Disease, Adult-Onset / Q000188:drug therapy*; D012460:Sulfasalazine / Q000009:adverse effects*; D016896:Treatment Outcome; D014581:Urticaria / Q000139:chemically induced; D014839:Vomiting / Q000139:chemically induced
chemical_list: D018501:Antirheumatic Agents; D012460:Sulfasalazine