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#278188 - 06/13/17 10:26 AM Sulfasalazine interactions, side effects
gardengal Offline
Registered Visitor

Registered: 06/20/13
Posts: 300
Loc: Mid-Atlantic US
Trying again to wean off of low-dose prednisone; methotrexate not a good option due to recent high liver numbers (back to normal since I've lost 25 pounds and gone on Mediterranean diet). Now rheumy is thinking SSZ might be helpful for peripheral problems. I take digoxin for AFib, the effectiveness of which may be affected by SSZ; also, I was given oral acetazolamide (Diamox) for severe eye pressure after cataract surgery and had intermittent sharp head pains. Since these are in the same drug "family", is it likely that SSZ will cause a similar side effect?
I know I'm blessed to still be at such a low level of meds, but am very hesitant to rock the boat unnecessarily. Hands, feet and hips are in revolt, though, and with labs saying I'm prediabetic now, it's probably time to seriously try to ditch the prednisone. Advice??
_________________________
Joani; 70-year-old with undifferentiated spondylitis and erosive inflammatory osteoarthritis in hands & wrists; spondy meds presently are low-dose prednisone, sulfasalazine, Voltaren gel for hands & elbows, Vitamin D, glucosamine w/ chondroitin, fossamax. Take other meds for heart issues & sinusitis. Blessed with great husband, 5 kids & their spouses, 10 beautiful grandchildren.

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#278241 - 06/15/17 05:55 PM Re: Sulfasalazine interactions, side effects [Re: gardengal]
SouthernMoss Offline
Registered Visitor

Registered: 03/12/13
Posts: 1756
Loc: MS
I've never taken SSZ and can't offer any advice there. If your liver numbers continue to remain normal now that you've lost weight, would MTX be a viable alternative at some point, or is it permanently off the table?
_________________________
Ginny - 56 year old female
Dx with USpA in March 2013; changed to AS in July 2015
Iritis and Scleritis
unicompartmental knee replacement June 2014
MTX, Humira, Cyclobenzaprine, plus Indomethacin ER as needed
Supplements: Folic Acid, Vitamin A, Vitamin D, Calcium, Fish Oil, Melatonin, Culturelle probiotic

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#278242 - 06/15/17 09:16 PM Re: Sulfasalazine interactions, side effects [Re: gardengal]
gardengal Offline
Registered Visitor

Registered: 06/20/13
Posts: 300
Loc: Mid-Atlantic US
Ginny, I don't think MTX is totally a no-go, but the GI doc said even with liver function within normal range now, he'd still want me to have a liver biopsy to rule out other liver disease (fibrosis?) and/or autoimmune condition before starting on MTX. He had no problem with me potentially starting the SSZ. Of course, this is the same doc (whose medical opinion I generally respect)who says it's fine for me to resume Tylenol Arthritis up to the maximum safe dose per label, while my rheumy had me immediately stop the 3/day TA I was taking when my liver function labs were way high. My sed rate is creeping back up, even with the low-dose prednisone, and my usual inflammation markers are reappearing. Ugh!
Thanks for the reply. I enjoy reading your knowledgeable, compassionate responses to the posts on these forums.
_________________________
Joani; 70-year-old with undifferentiated spondylitis and erosive inflammatory osteoarthritis in hands & wrists; spondy meds presently are low-dose prednisone, sulfasalazine, Voltaren gel for hands & elbows, Vitamin D, glucosamine w/ chondroitin, fossamax. Take other meds for heart issues & sinusitis. Blessed with great husband, 5 kids & their spouses, 10 beautiful grandchildren.

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#278258 - 06/16/17 03:32 PM Re: Sulfasalazine interactions, side effects [Re: gardengal]
SouthernMoss Offline
Registered Visitor

Registered: 03/12/13
Posts: 1756
Loc: MS
Thank you for your kind remarks. There were so many people who helped me at the beginning of this journey, and I like to return the favor when I can.

Isn't that frustrating when doctors contradict themselves and different doctors tell you different things!
_________________________
Ginny - 56 year old female
Dx with USpA in March 2013; changed to AS in July 2015
Iritis and Scleritis
unicompartmental knee replacement June 2014
MTX, Humira, Cyclobenzaprine, plus Indomethacin ER as needed
Supplements: Folic Acid, Vitamin A, Vitamin D, Calcium, Fish Oil, Melatonin, Culturelle probiotic

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#278259 - 06/16/17 04:36 PM Re: Sulfasalazine interactions, side effects [Re: gardengal]
Banana Offline
Registered Visitor

Registered: 07/23/06
Posts: 6500
Loc: New York
SSZ is a milder drug and often people have mild reactions. When I took it, I took one pill for a period of time and than two pills etc until the full dose and my bloodwork was ok. I had not problems with it, except it did not help much.

MTX worked much better and I screwed myself for refusing it after I failed a couple meds. I took it for maybe 5 years with no problems. Liver numbers went up twice but came back to normal and all was fine.

Good luck, Anna
_________________________
Actema IV once a month (with pre loading for allergic reaction), Cymbalta x1 daily, Arava 20mg daily. Diagnosed with AS in 2004, suffered undiagnosed since 1982.

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#278270 - 06/17/17 10:04 PM Re: Sulfasalazine interactions, side effects [Re: gardengal]
gardengal Offline
Registered Visitor

Registered: 06/20/13
Posts: 300
Loc: Mid-Atlantic US
Thanks, Anna, that's good to know. I believe my rheumy will start with a low dose of SSZ and see how it goes. Will have to closely monitor my Digoxin level - ending up in the ER/ICU with paroxysmal AFib again wouldn't be my choice of "side effects..." My pharmacist suggested that, if I (and/or my cardiologist) want to check it more closely than insurance deems acceptable, I could go to the hospital lab and explain the situation and tell them that I want to just pay lab cost myself and not bill Medicare or supplemental insurance. He said that many routine single lab tests are only about $15 or so, if the patient is willing to pay cash up front. Wow!
_________________________
Joani; 70-year-old with undifferentiated spondylitis and erosive inflammatory osteoarthritis in hands & wrists; spondy meds presently are low-dose prednisone, sulfasalazine, Voltaren gel for hands & elbows, Vitamin D, glucosamine w/ chondroitin, fossamax. Take other meds for heart issues & sinusitis. Blessed with great husband, 5 kids & their spouses, 10 beautiful grandchildren.

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#278276 - 06/19/17 01:59 PM Re: Sulfasalazine interactions, side effects [Re: gardengal]
RAHMBA Offline
Registered Visitor

Registered: 06/27/12
Posts: 490
Loc: Los Angeles, CA
I also think it's smart to come off of prednisone if your doc thinks you can. SSZ & MTX are not effective for AS, axial spondyloarthritis. If you do go on SSZ, please make sure the lab/doc checks your blood tests for the very rare, but serious, reaction. my doc sat on that lab report, which was not good.
Wishing your treatments are effective. Best,
_________________________
AS, U C, Iritis, migraines. HLA-B27neg. Yoga (instructor) & spin. No meds at this time. Dx 1989. SAA member/donor since 1993. All my posts are personal opinion/feelings and do not represent the SAA. Help find a cure & support others by donating to the SAA.

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#278284 - 06/20/17 09:53 AM Re: Sulfasalazine interactions, side effects [Re: gardengal]
gardengal Offline
Registered Visitor

Registered: 06/20/13
Posts: 300
Loc: Mid-Atlantic US
I've tried twice to wean off the 5-mg prednisone that I've taken since April 2013 - once was off for a whole month before I ended up in tears and agony in my rheumy's office. How frustrating. Until about 5 years ago, I took virtually no meds, other than ibuprofen and glucosamine/chondroitin.

What "very rare, but serious, reaction" are you referring to that I need to watch for in my labs? Would my rheumy (or cardiologist?) need to be alerted to this?

Thanks -
_________________________
Joani; 70-year-old with undifferentiated spondylitis and erosive inflammatory osteoarthritis in hands & wrists; spondy meds presently are low-dose prednisone, sulfasalazine, Voltaren gel for hands & elbows, Vitamin D, glucosamine w/ chondroitin, fossamax. Take other meds for heart issues & sinusitis. Blessed with great husband, 5 kids & their spouses, 10 beautiful grandchildren.

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