[Changes in the blood picture in sulfasalazine therapy of rheumatoid arthritis]

Out of 160 patients with confirmed resp. classical rheumatoid arthritis, according to the ARA criteria, six patients under treatment with sulfasalazine granulocytopenias, in association with thrombocytopenia in one case, and with a decrease in erythrocytes in two cases, have been observed. Remarkably, in all six cases the relatively early hemogram alterations appear as soon as the start of therapy and prompt normalization of blood counts occurs after instant termination of sulfasalazine therapy. Possible mechanisms for the occurrence of these sulfasalazine-induced hematological complications are discussed. These observations, also described by other authors, should be a cause for more frequent blood count tests during sulfasalazine therapy, at least during the first 3 months on a weekly basis. Sulfasalazine represents an asset among the rather limited number of basic therapies available for chronic rheumatoid arthritis. Despite the fact that it is comparatively well tolerated, a close follow-up of the therapy, especially during the initial phases of treatment, is of utmost importance in order to seize upon these reversible hematological disorders at an early stage and thus avoid more serious complications.