Methotrexate vs Sulfasalazine - side effects


I was wondering if anyone has tried both these medications and how the side effects compare..

I’ve been on methotrexate since being diagnosed with RA is October last year, and altho my inflammation and paid has reduced a little, I can’t cope with the side effects. I lose about 3 days after my MTX dose, from extreme fatigue, lack of appetite, nausea, painful cystic acne, but the hardest one is the massive decline in my mental health since I started taking it. I appreciate adjusting to the new me with RA also will be affecting me mentally.

I guess I haven’t really accepted I have to take medication.. I just want to stop.. but I know the chances are the disease will just progress more rapidly.

so my consultant has switched me to sulfasalazine and I’m just wondering how these side effects may differ.. as they appear to sound similar.. and the yellowing skin..

I appreciate everyone tolerates drugs differently, but any experiences would be greatly received. Positive ones ideally..

thank you


  • jamieA
    jamieA Member Posts: 605

    Hi @Kate1701

    I was put on Sulfasalazine at the end of October 2020 when I was diagnosed with psoriatic arthritis and then MTX was added in February 2021. The only side effect that I've had from 3gms daily of sulfasalazine is orange urine. MTX has caused fatigue either the following day or two days after I take it. My MTX dosage was initially 15mg and was then increased to 20mg. Neither sulfasalazine nor MTX stemmed my psoriatic arthritis and so I was put on a biologic in July 2021 - the rheumatologist said I still needed to continue both the sulfasalazine and MTX. I took a heart issue in May 2021 - tachycardia and atrial fibrillation - and tachycardia again in October 2021. During the October issue a rheumatologist visited me in the cardiac wing of the hospital and reduced my MTX to 10mgs. I've not had a recurrence of the heart issue since. I've since seen a cardiologist who thinks my heart issue was caused by me having covid in March 2020 but I'm not convinced.

    On the plus side the biologic I'm on has helped significantly with no active side effects - though it does leave me classed as immunocompromised.

  • Not both, sorry.

    Just the Sulfasalazine. 2000mg per day. Took approximately 10 weeks to notice any slight reduction in inflammation.

    Side effects included enthusiastic nausea, intermittent headaches, tension/tense, low mood, orange pee, indigestion/bloated, gassy, stomach upsets. getting so intense at one point I almost quit taking them.

    Pleased I persisted though. I reached a stage whereby I experienced discomfort in large joints as opposed to them being painful, swollen and hot.

    The low mood/anxiety could be a result of personal circumstances and trying to get my head around this (RA) being a progressive disease (no cure) and limitations on daily activities. The nausea has calmed and I can eat something again. Nothing like the appetite I once had.

    All in all I'm in favour. I notice a difference between what my joints looked and felt like 6 months ago, to today. Not skipping and dancing by any stretch of the imagination. But I can walk. (without analgesia) That's a positive right there.

  • frogmorton
    frogmorton Member Posts: 29,020

    Morning @Kate1701

    Didn't anyone suggest you tried your MTX via injection? I only say because some people do find they suffer less nausea on it that way. Still that probably wouldn't help with the side effects like exhaustion.

    Over the years on here I have noticed that no two of us seem to get the same side effects with any medication. What suits one doesn't suit another so it is a case of trial and error I think.

    Still you definitely gave the MTX a fair try.

    wish you the best of luck on the Sulf 🤞

    Toni x

  • Kate1701
    Kate1701 Member Posts: 14

    Thank you for your experiences.. I’m so apprehensive of changing meds.. and not sure it’s the right thing to do.. but I guess have to try. Im having a complete break from anything for 2 weeks as an in a bad place emotionally so consultant agreed this is ok..

    @ toni - yes injectable was discussed, I think he wants to see how I respond to the sulfasalazine.. my disease activity itself has reduced, but the fatigue is constant.

    @movingslowly - similarly agree mood could be down to not yet adjusting to diagnosis.. I just seen to be going through a really intensely anxious period.. I live with PTSD, and this current episode is the most intense & debilitating so far.. I’m not sure is linked with my RA or not..

    thank you again

  • frogmorton
    frogmorton Member Posts: 29,020

    I think probably most of us live with mental health issues to a greater or lesser extent and a diagnosis like this is bound to have a huge impact on anyone. So who knows sadly. Taking time and the support of what sounds like a good Rheumatologist is a huge help.

    Keep in touch @Kate1701 let us know how you get on.

    Sending some ((()))

    Toni x