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The three week sulphasalazine syndrome
H Brooks1, H G Taylor, F E Nichol
1Department of Rheumatology, Leicester Royal Infirmary, United Kingdom.
Clinical Rheumatology
|December 1, 1992
Summary
A rare sulphasalazine reaction can cause fever, rash, and hepatitis in rheumatoid arthritis patients. Prompt recognition and corticosteroid treatment are crucial for managing this potentially fatal adverse effect.
Area of Science:
- Rheumatology
- Clinical Pharmacology
Background:
- Rheumatoid arthritis (RA) is a chronic autoimmune disease.
- Sulphasalazine is an established disease-modifying antirheumatic drug (DMARD) used in RA treatment.
Observation:
- A 53-year-old male patient with sero-negative RA developed fever, rash, and hepatitis.
- Symptoms appeared 3 weeks after initiating sulphasalazine therapy.
Findings:
- The patient exhibited T cell lymphocytosis, eosinophilia, and classical complement pathway activation.
- High-dose corticosteroids led to a favorable response.
Implications:
- This case highlights a rare but characteristic adverse drug reaction to sulphasalazine.
- Increased sulphasalazine use may lead to more frequent encounters with this reaction by rheumatologists.
- Timely diagnosis is essential to prevent potentially fatal outcomes and misdiagnosis with other systemic conditions.