Sulfasalazine and fatigue?

Arcardia89

Hi, This is my first post and hoping that someone out there can answer my questions?
I have PA and came off Sulfasalazine 6 weeks ago due to side-effects: problems sleeping, low mood, poor concentration and extreme fatigue. All the side-effects bar the fatigue have now cleared-up. Has anyone else experienced this?

Could this just be another evolution of my PA as whilst I have constant low-level inflammation in my wrists and elbows, the fatigue is the worst it has been in 6 years. It is that bad I've been off-work 2 months and may have to consider going p/t.

I have been on Leflunomide for 2 years, which is ok, but I still have low-level inflammation and had to come off Mtx due to problems with my liver.

Any thoughts?

stickywicket

Hello Arcadia89 and welcome to the forum

I've never done sulphasalazine and had a problem with leflunomide though methotrexate is great for me. I have RA.

My thoughts are simply that fatigue is part and parcel of our diseases, especially when they're not under control. It's easy to blame the meds for stuff that goes wrong and clearly the sulph caused most of your problems but it seems to me that the fatigue is caused by the disease and you need something to replace the sulph. If you have ongoing inflammation then the lef alone isn't dealing with the problem.

I think you should contact your rheumatology helpline for advice. They'll have your blood results and are the only ones who can prescribe. (We're good at sympathy though )

dreamdaisy

Hello, I have PsA (psoriatic arthritis) and have been on sulph for years, it helps to control my skin but does very little for the arthritis. Fatigue? I'm a classic case of TATT (tired all the time) which may be to do with my triple therapy and / or my PsA and OA: tiredness goes hand-in-hand with arthritis due to on-going pain, possibly poor quality sleep and the effort sometimes required to achieve even the basics of life. DD

theresak

Hi, and welcome.

I was on sulph years ago, when I was first diagnosed, though it did nothing to control the RA. I don't remember any troublesome side effects, but firmly believe that fatigue goes hand in hand with RA, no matter which drug you ate on, and I've been on a lot. Only two gave me real problems - leflunomide & MTX put me in hospital.

I don't think the fatigue aspect is explained properly when one is first diagnosed - at least it wasn't explained to me. Now, after several years living with RA I feel I know chapter & verse about the tiredness. It's a bit of a vicious circle, as you go to bed tired out, struggle to turn over/manipulate duvet/find comfortable position etc, so when morning comes you're still tired.

Once your RA is better controlled things should improve, so hopefully there is light at the end of the tunnel.

Arcardia89

Hi,

Thank you all for your help and advice?

Can I ask what may seem a dumb question, but do you feel tired even when you only have mild inflammation?

Thanks again.

stickywicket

It's not a dumb question at all but fatigue can come from various different aspects of our lives, not only the inflammation.

Low iron levels can cause fatigue. According to my doc, both RA and the meds that we take for it can cause this. A quick course of iron tabs has always sorted me out.

Low levels of Vitamin D can also cause fatigue and it seems that Vit D deficiency is becoming more common. Best not to self-medicate though as one can have too much of it. However, oily fish, eggs and fortified cerals are all good, natural sources of it.

I think it's worth having a chat with either your rheumatology people or GP.

Boomer13

Hi Arcadia89;

I was on Sulfasalazine for a year and recently stopped it due to nausea and vomiting. The fatigue I have with PsA is horrendous and overwhelming. In my case, it's definitely due to the illness as it goes up and down with pain levels but is not obviously the result of pain. For example, I will have two or three days often where I am constantly sleepy and need to lie down after almost any activity. This is consistently followed by a worsening of my PsA. It very hard to deal with and I would take pain without so much fatigue any time.

All that said, this does highlight how difficult it is to determine drug side-effect from the illness. With me, this is a constantly evolving and changing issue and one where keeping a symptom diary has helped me answer the question for myself quite a few times.

Anna

PS My signs of inflammation are always subtle too.

Tia1723

No exact answer to your question but, fatigue is a huge part of living with PA. Because patients with psoriatic arthritis shed skin cells every four days (instead of every month, as do people with normal immune systems), they consistently lose protein and nutrients, which leads to malnutrition and exhaustion. Replenishing lost nutrients by consuming foods high in vitamin B12— including liver, shellfish, and fortified breakfast cereals — or taking B12 supplements may help boost energy levels.
Just as another thought, did you check your vitamin D levels off let? Though vitamin D deficiency is not been linked to PA, it is very common and people who have low vitamin D level, they also tend to feel more fatigued.

Love,Tia.

dreamdaisy

Yup. I've had fantastic blood results but been on my knees with tiredness, rubbish bloods and feeling reasonable (but my world is a skewed). It's odd, there is no rhyme nor reason. DD