title: Can sulfasalazine therapy induce or exacerbate Wegener's granulomatosis?
abstract: 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.
authors.affiliation: Department of Rheumatology, University Medical Centre Nijmegen St Radboud, the Netherlands.
authors.forename: N H A M
authors.initials: NH
authors.lastname: Denissen
authors.forename: J G P
authors.initials: JG
authors.lastname: Peters
authors.forename: R
authors.initials: R
authors.lastname: Masereeuw
authors.forename: P
authors.initials: P
authors.lastname: Barrera
mesh_terms: 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*
chemical_list: D018501:Antirheumatic Agents; D005938:Glucocorticoids; D012460:Sulfasalazine; D003520:Cyclophosphamide; D002097:C-Reactive Protein; D008775:Methylprednisolone