Sulfasalazine and MTX

mylo
mylo Member Posts: 53
Hi
I've put a post on the living with arthritis forum, so I hope you don't mind me asking the same question here!
I've been taking 20 mgms MTX for RA since last autumn, but when I saw the rheumy last week he said he'd like to add in sulfasalazine as well. I'm getting a bit anxious about this, but have to wait until Friday to see the rheumy nurse to get the prescription and all the info. I just wondered whether it can cause many side effects, if people tend to struggle with it etc etc? I know we're all different and have different reactions to the meds, but if you can give me some reassurance, I'd really appreciate it. I still have some swelling in quite a few joints, which I think is why he's prescribing it.
Many thanks, Jane

Comments

  • helpline_team
    helpline_team Posts: 2,548
    edited 30. Nov -1, 00:00
    Hi Jane,

    Of course we don't mind if you put the same kind of question to us as elsewhere on the forum.

    As far as reassuring you about this new treatment option, a key element will be knowing that you will be properly monitored. You will already be familiar with the importance of regular liver function tests.

    An important issue may be your knowledge about your self-management, arthritis, and the relationship with your rheumatology clinic.

    You might find it helpful to come to one of our self-management courses. And if you e-mail [email protected] with your full name and postal address I can post you more details from our drugs reference information on these drugs. (in brief with sulphazelazine - keep your fluids up. Fever/rash or bleeding bruising are the key things to discuss with the doctor)

    These treatments are well known, so the monitoring does work.

    I wonder how long you've been on methotrexate (mtx) so far? I see from your profile you are in your 50s. I wonder if you've had another disease modifying drug (dmard) before mtx? Because as sulphazelazine is being proposed as being added you soon may be getting into the territory of the NICE guidance on qualifying for anti TNF drugs.

    You may want to ask the clinic how high your Disease Activity Score (DAS) is. A high score would be necessary for you to qualify for anti TNF, and you would have to have tried at least 2 dmards

    I hope that's helpful
    Guy
  • mylo
    mylo Member Posts: 53
    edited 30. Nov -1, 00:00
    [Hi Guy

    Many thanks for the reply; I'm trying not to , but I'm getting really anxious about this extra drug.

    I started methotrexate 7.5 mg in August 08, this was increased to 15 mg in Sept and then to 20 mg in late Oct. The consultant recommended taking folic acid six days a week from October, and I've felt fine since then.

    Thanks also for suggesting I request the drugs reference information, which I'll do. I have already attended an Arthritis Education Group at my local hospital (Derby) which has helped a great deal with my management of the RA - I don't know whether the ARC sessions would be different?

    I'm almost talking myself into having a difficult time this week because of my worry about the sulfasalazine.

    Can you suggest any key questions I should be asking when I see the rheumy nurse on Friday please? - when I first started on methotrexate, I had a very comprehensive counselling session and I guess this may be similar.

    Thanks again, Jane
  • paularthritiscarehelpline
    paularthritiscarehelpline Member Posts: 1
    edited 30. Nov -1, 00:00
    Hi Jane,

    It sounds like you're giving yourself a really hard time over this. There are no guarantees that you won't experience an adverse reaction to sulfasalazine, though you say you're fine taking a pretty high dose of MTX so I would take this as a good sign. Some people who can't tolerate MTX have no problems with sulfasalazine and vice versa. The important thing to remember is that you are going to be closely monitored and if you have a bad reaction to it, they'll take you off it immediately.

    The questions I would be thinking about asking your rheumy nurse would be along the lines of:

    Why does the rheumatologist think it necessary for me to take this?
    What are the efficacy scores for sulfa in combination with MTX?
    What are the results of my last blood test like? Are they improving?
    What's my Disease Activity Score?

    Don't forget that the most important marker of your RA is how your feeling in yourself. If you feel that things have been improving, it's perfectly valid to ask if it's possible to wait a while longer before starting sulfa to see how it goes. If there's anything you can think of to help you take your mind off all of this then go for it as tying yourself up in knots always seems to make the pain worse.

    There is a Challenging Arthritis course coming up in Derbyshire in April which might be worth looking into. You can find out more about it through the Central England office.

    Best wishes
    Paul







    mylo wrote:
    [Hi Guy

    Many thanks for the reply; I'm trying not to , but I'm getting really anxious about this extra drug.

    I started methotrexate 7.5 mg in August 08, this was increased to 15 mg in Sept and then to 20 mg in late Oct. The consultant recommended taking folic acid six days a week from October, and I've felt fine since then.

    Thanks also for suggesting I request the drugs reference information, which I'll do. I have already attended an Arthritis Education Group at my local hospital (Derby) which has helped a great deal with my management of the RA - I don't know whether the ARC sessions would be different?

    I'm almost talking myself into having a difficult time this week because of my worry about the sulfasalazine.

    Can you suggest any key questions I should be asking when I see the rheumy nurse on Friday please? - when I first started on methotrexate, I had a very comprehensive counselling session and I guess this may be similar.

    Thanks again, Jane
  • mylo
    mylo Member Posts: 53
    edited 30. Nov -1, 00:00
    Hi Paul

    Many thanks for your reply - all very helpful, and I'll certainly ask the questions you suggest, and I'll look into the Challenging Arthritis course in April.

    Thanks again, Jane

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