Jung J H, Jun J B, Yoo D H, Kim T H, Jung S S, Lee I H, Bae S C, Kim S Y
Department of Internal Medicine, Eulji Medical College Hospital, Taejon, Korea.
Clin Exp Rheumatol. 2000 Mar-Apr;18(2):245-8.
Sulfasalazine (SSZ) is an anti-rheumatic drug that has been used to treat chronic arthritis. In many reports, the use of SSZ in children with systemic onset juvenile rheumatoid arthritis (JRA) revealed frequent side effects which required discontinuation of the drug. We examined whether there were frequent side effects of SSZ in patients with adult-onset Still's Disease (AOSD).
From July 1990 to April 1998, we followed 41 AOSD patients. Ten were given SSZ for the treatment of arthritis and the side effects were studied. We also studied 109 consecutive patients with RA who had been given SSZ, as a control group. In addition, we retrospectively studied the side effects and efficacy of SSZ in both groups through their medical records.
Six patients (60%, p < 0.01) with AOSD experienced side effects ranging from mild ones like abdominal pain, nausea and vomiting, urticaria, and facial flushing to severe ones such as high fever, hypotension, and severe myelosuppression as well as fulminant hepatitis, which led to the death of one patient. However, 16 patients (14.7%) with RA stopped using SSZ due to mild side effects such as rash, urticaria, gastrointestinal troubles, mild leukopenia, and fever. Three AOSD patients (30%, p = 0.053) and 15 RA patients (13.8%) stopped using SSZ due to its inefficacy.
We conclude that SSZ appears to have frequent severe side effects in AOSD, as in systemic onset JRA. These potential adverse effects of SSZ should be considered when it is used to treat chronic arthritides with systemic symptoms. Further study of SSZ in the treatment of AOSD in a multi-center, placebo-controlled environment is needed.
柳氮磺胺吡啶（SSZ）是一种用于治疗慢性关节炎的抗风湿药物。许多报告显示，在患有全身型幼年类风湿关节炎（JRA）的儿童中使用SSZ时，副作用频发，常需停药。我们研究了成人斯蒂尔病（AOSD）患者使用SSZ是否也有频发的副作用。
1990年7月至1998年4月，我们对41例AOSD患者进行了随访。其中10例接受SSZ治疗关节炎，并对其副作用进行研究。我们还研究了109例连续接受SSZ治疗的类风湿关节炎（RA）患者作为对照组。此外，我们通过病历回顾性研究了两组患者使用SSZ的副作用及疗效。
6例（60%，p<0.01）AOSD患者出现副作用，从轻微的腹痛、恶心、呕吐、荨麻疹和面部潮红到严重的高热、低血压、严重骨髓抑制以及暴发性肝炎，其中1例患者死亡。然而，16例（14.7%）RA患者因皮疹、荨麻疹、胃肠道不适、轻度白细胞减少和发热等轻微副作用而停用SSZ。3例（30%，p = 0.053）AOSD患者和15例（13.8%）RA患者因SSZ无效而停药。
我们得出结论，与全身型JRA一样，SSZ在AOSD患者中似乎也有频发的严重副作用。在使用SSZ治疗伴有全身症状的慢性关节炎时，应考虑这些潜在的不良反应。需要在多中心、安慰剂对照的环境中进一步研究SSZ治疗AOSD的效果。
