Can sulfasalazine therapy induce or exacerbate Wegener's granulomatosis?
Sulfasalazine (SSZ) can induce serological and clinical autoimmune reactions but the occurrence of SSZ-related Wegener's granulomatosis (WG) has not been reported before. We describe two patients with rheumatoid factor (RF)-positive rheumatoid arthritis (RA) who developed biopsy-proven WG with serious organ involvement during SSZ therapy. The pathogenetic mechanism that explains the relationship between SSZ and the occurrence of a de novo anti-neutrophil cytoplasmic antibody (ANCA)-related vasculitis or a flare is discussed. We propose that WG can be a rare complication of SSZ therapy and that this, like other autoimmune adverse events of this drug, is mediated by SSZ-induced apoptosis.
Denissen
N H A M
NH
Department of Rheumatology, University Medical Centre Nijmegen St Radboud, the Netherlands.
Peters
J G P
JG
Masereeuw
R
R
Barrera
P
P
D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000009:adverse effects / Q000627:therapeutic use; D002097:C-Reactive Protein / Q000378:metabolism; D003520:Cyclophosphamide / Q000627:therapeutic use; D018450:Disease Progression; D005938:Glucocorticoids / Q000627:therapeutic use; D014890:Granulomatosis with Polyangiitis / Q000188:drug therapy* / Q000503:physiopathology*; D006801:Humans; D008775:Methylprednisolone / Q000627:therapeutic use; D012460:Sulfasalazine / Q000009:adverse effects* / Q000627:therapeutic use*
D018501:Antirheumatic Agents; D005938:Glucocorticoids; D012460:Sulfasalazine; D003520:Cyclophosphamide; D002097:C-Reactive Protein; D008775:Methylprednisolone