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Haematological side-effects of sulphasalazine in inflammatory arthritis
N D Hopkinson1, F Saiz Garcia, J M Gumpel
1Department of Rheumatology, Northwick Park Hospital, Harrow, Middlesex.
Abstract:
The nature and incidence of haematological side-effects of sulphasalazine was sought in a retrospective study of 130 sulphasalazine-treated patients with chronic inflammatory arthritis. Macrocytosis was seen to occur in 27 patients (20.8%) and four patients (3%) developed a macrocytic anaemia. Only eight of 23 macrocytic patients had low red cell folate levels, three of whom were anaemic. An increased risk of developing macrocytosis was seen with doses of sulphasalazine greater than 2 g per day. In most patients the macrocytosis was noted during the first 6 months but did occur in the second and third 6-month period of treatment. Only one patient (0.8%) developed neutropenia and no cases of thrombocytopenia were observed. Regular blood counts should be performed while patients remain on treatment but haematological side-effects are seldom the reason for withdrawal of sulphasalazine.
Insights
Sulphasalazine can cause macrocytosis (enlarged red blood cells) in over 20% of patients with inflammatory arthritis, with a higher risk at doses above 2g daily. Serious blood count issues like neutropenia are rare.
Area of Science:
- Hematology
- Pharmacology
- Rheumatology
Background:
- Sulfasalazine is a common treatment for chronic inflammatory arthritis.
- Understanding its hematological side effects is crucial for patient safety.
Purpose of the Study:
- To investigate the nature and incidence of hematological side effects of sulfasalazine.
- To identify risk factors and patterns of these side effects.
Main Methods:
- Retrospective study of 130 patients treated with sulfasalazine.
- Analysis of blood counts and clinical data.
Main Results:
- Macrocytosis occurred in 20.8% of patients; macrocytic anemia in 3%.
- Increased risk of macrocytosis observed with sulfasalazine doses > 2g/day.
- Macrocytosis typically developed within the first 6 months of treatment.
- Neutropenia (0.8%) and thrombocytopenia were rare.
Conclusions:
- Sulfasalazine commonly causes macrocytosis, particularly at higher doses.
- Regular blood monitoring is recommended during sulfasalazine treatment.
- Hematological side effects rarely necessitate treatment withdrawal.