Sulfasalazine is an anti-inflammatory drug used to treat bowel diseases like ulcerative colitis and rheumatoid arthritis. It works by inhibiting the production of cytokines and inflammatory mediators. Common side effects include gastric distress, headache, and nausea. It is generally considered safe in pregnancy but can cause discoloration of urine or skin. Precautions must be taken with elderly patients or those with allergies or asthma. Drug interactions can also increase risks, so patients should inform their doctors of other medications.

1. SULFASALAZINE
Walaa Fahad Ali Aljuaid .

2. WHAT IS SULFASALAZINE?

3. SULFASALAZINE IS AN ANTI-
INFLAMMATORY AGENT USE TO
RELIVE THE PAIN OF THE
BOWEL DISEASES AND
RHEUMATOID ARTHRITIS AND
OTHER DISEASES .

4. RHEUMATOID
ARTHRITIS?

5. RHEUMATOID ARTHRITIS (RA) :
➤ is an autoimmune disease in
which the body’s immune
system mistakenly attacks the
joints , this creates
inflammation that causes the
tissue that lines the inside of
joints (the synovium) to
thicken, resulting in swelling
and pain in and around the
joints.
REFERENCE : ,Rowland W. (Bing) Chang,2011,
Arthritis Foundation organization,

6. ➤ it can damage cartilage as well as the bones themselves.
➤ Joints can become loose, unstable, painful and lose their
mobility and joint deformity also can occur.
➤ Joint damage cannot be reversed, and because it can
occur early, we recommend early diagnosis and aggressive
treatment to control RA.

7. RHEUMATOID ARTHRITIS CAUSES :
➤ The cause of RA is not yet fully understood but the doctors
think :
➤ Obesity
➤ Genetic
➤ Trauma
➤ Bacterial or viral infections
➤ could be the reasons of RA .

8. RHEUMATOID ARTHRITIS SYMPTOMS
➤ In the early stages, people with RA may not initially see
redness or swelling in the joints, but they may experience
tenderness and pain.
➤ Joint pain, tenderness, swelling or stiffness for six weeks or
longer
➤ Morning stiffness for 30 minutes or longer
➤ More than one joint is affected
➤ Small joints (wrists, certain joints of the hands and feet) are
affected
➤ The same joints on both sides of the body are affected.

9. DIAGNOSIS
➤ Medical History : ( recent and current symptoms
(pain, tenderness, stiffness, difficulty moving).
➤ Physical Examination
➤ Blood Tests will measure inflammation levels
(antibodies) (RF)
➤ Erythrocyte sedimentation rate (ESR) and C-
reactive protein (CRP) level
➤ Radiological .
➤ 2010 Rheumatoid Arthritis Classification Criteria

11. TREATMENT

12. ➤ The goals of rheumatoid arthritis (RA) treatment are to:
➤ Stop inflammation (put disease in remission)
➤ Relieve symptoms
➤ Prevent joint and organ damage
➤ Improve physical function and overall well-being
➤ Reduce long-term complications

13. NON-PHARMACOLOGIC
➤Rest, weight
reduction,
physical therapy.
➤Surgery such as
joint replacement
➤Patient education
PHARMACOLOGIC
➤DMARDs ( disease-
modifying antirheumatic
drugs)
➤NSAIDs
➤SAID (Corticosteroids)
TREATMENT

15. BACK TO SULFASALAZINE
REFERENCE :Peppercorn MA "Sulfasalazine. Pharmacology, clinical use, toxicity, and related new drug
development." Ann Intern Med 101 (1984): 377-86

16. SULFASALAZINECLASS OF
MEDICATION :
SULFONAMIDE .
DOSES AND
DOSAGE FORM :
ORAL ( TABLET 500 MG ) RECTAL ( ENEMA ) 3 G
MECHANISM OF
ACTION :
THE ACTION OF ANTI-INFLAMMATORY EFFECTS DUE TO 5-
AMINOSALICYLIC ACID SUBSTANCE ( PRODRUG ) , AND IT IS INHIBIT
THE PRODUCTION CYTOKINES AND INFLAMMATORY MEDIATORS .
SIDE EFFECTS :
COMMONLY GASTRIC DISTRESS , HEADACHE , NAUSEA , VOMITING
AND ANOREXIA , INCREASE SENSITIVITY TO SUNLIGHT .

17. SULFASALAZINEPREGNANCY
CATEGORY :
CATEGORY B , THERE IS NO RISK ON HUMANS BUT USE WITH
CAUTION IN LACTATION BECAUSE IT IS DISTRIBUTE WITH MILK.
TOXICITY : SULFONAMIDES HAVE BEEN ASSOCIATED WITH RENAL TOXICITY DUE
TO CRYSTALLURIA : NEPHROTIC SYNDROME AND HEMOLYTIC-UREMIC
SYNDROME .
CONTRAINDICATION : THE HYPERSENSITIVITY TO SALICYLATE , INTESTINAL OR URINARY
OBSTRUCTION .
PRECAUTIONS: SULFASALAZINE MEDICATION SHOULD BE GIVEN WITH CAUTION
TO PATIENTS WITH SEVERE ALLERGY OR BRONCHIAL ASTHMA.

18. ADMINISTRATION :
taking after meal and with adequate fluid intake to prevent
gastric ulcer , crystal urea formation or stone .
take the medication according your doctor instruction , do
not miss doses as possible as you can .

19. IMPORTANT SAFETY INFORMATION:
➤ 1- avoid the sun or use sunscreen ( sunburn may occur
due to the sulfasalazine increase skin sensitivity to
sunlight ) .
➤ 2-discoloration of urine or skin into orange-yellow it is
normal .
➤ 3-Diabetes patients - Sulfasalazine may affect blood sugar
( hypoglycemia )
➤ 4- elderly patient must take the medication with caution .

20. ➤ 5- Sulfasalazine should not be used in CHILDREN
younger than 2 years old , safety have not be conformed
➤ 6- if you take other medication of going to under lab test
or investigation tell your doctor about it .
➤ 7- if you notice any weird symptoms or skin rash tell your
doctor about it .

21. DRUG INTERACTIONS :
➤ 1- tacrolimus increase renal toxicity .
➤ 2- cyclosporine increase renal toxicity and organ transfer
rejection .
➤ 3- warfarin increase bleeding risk .
➤ 4- Sodium nitrite due to methemoglobinemia condition
( reduce oxygen transferring capacity ) .
➤ 5-reduced absorption of folic acid and digoxin

22. ➤ 1- Ulcerative colitis which is a
disease that causes
inflammation and sores
(ulcers) in the lining of the
large intestine (colon ).
➤ Crohn's disease
➤ Juvenile arthritis
OTHER USES OF SULFASALAZINE

23. “There are no secrets to success. It is
the result of preparation, hard work,
and learning from failure.
-Colin Powell

24. THANK YOU