A bad reaction to Sulfasalazine

I had quite an unexpected bad reaction to sulfasalazine, but it’s not an unknown one.

It started with flu-like symptoms, a day after my first full dose.

• Massive headache
• Sore throat
• Running nose and scratchy eyes
• A phlegmy cough
• Aching joints and muscles
• Slight fever (38C)

I thought I’d just picked up a virus at the gym - I’m well practiced at taking on any and all viral infections from public places!

Sunday saw a small rash appear at the back of my neck, but easily explained away by a irritating velcro seal on my hoody rubbing the skin.

Come Monday morning, I was covered in red spots from head to toe, a few nicely blistered, and feeling like death.

The rash was clearly described in the medication information pamphlet (I’d forgotten about the flu symptoms that appear first). That rash is the signal to immediately stop taking sulfasalazine, and to never take it again.

Severe reaction to sulfasalazine

If further doses are taken, the bad reaction can progress to full blown Stevens-Johnson syndrome (don’t follow that Wikipedia link if you are squeamish!), where the skin massively blisters and peels off. Eye and lung damage is a very high risk, as are secondary infections.

This is an emergency, typically requiring intensive care for an extended period.

There are also other serious conditions caused by hypersensitivity to sulfasalazine.

Luckily, I noticed it early, and saw the doctor immediately.

After checking the rash, both the GP and rheumatologist kept me on cortisone and antibiotics, under a watchful eye for worsening symptoms for a few days, until a bed becomes available in the rheumatology ward at the hospital.

Important - if you develop a rash, especially with flu symptoms, while on sulfasalazine - stop taking it and immediately see a doctor.

Most of the bad reactions are due to sensitivity to the sulphur component in the medication (sulphonomides). I was sensitive to the other part - the salicylic acid, sulfa_sala_zine - but had the same side effects as those who react to the sulphonomides.

Aspirin and sulfasalazine

I have known for decades that I was allergic to aspirin, and I have develop a rash in reaction to the salicylic acid used in topical skin treatments for acne.

Sulfasalazine is closely related to aspirin, which could explain my reaction.

Next steps for the rheumatologist?

It’s off work again and back to stay in hospital on Wednesday for me, to let them see the reaction, do more tests to make sure I’m ok, and work out what medication to try next to treat the spondyloarthritis/psoriatic arthritis without destroying the already damaged kidneys.

In the meantime, I’m keeping my fluids up, resting, trying not to scratch, and using loads of eye drops to hopefully prevent any lasting eye damage.

Look on the bright side: Maybe I will get at least one crochet blanket finished while I’m there.