Neutropenia in patients with inflammatory arthritis treated with sulphasalazine. Ann Rheum Dis

SUMMARY This report describes two patients who developed severe neutropenia one month after starting sulphasalazine (SASP) as treatment for their inflammatory joint disease. Both recovered on stopping the drug. Six further cases (out of a series of 180 patients with inflammatory forms of arthritis receiving SASP therapy) in whom transient leucopenia occurred are also recorded. These patients were able to continue the drug under close supervision. Sulphasalazine is a useful addition to the small number of slow acting antirheumatic drugs (SAARDs) and, despite this complication, is safer than other SAARDs. Careful monitoring of patients is essential, however, particularly in the early stages of treatment, to detect this adverse reversible reaction promptly. Sulphasalazine is now becoming established as a slow acting antirheumatic drug. Short term clinical trials and long term open studies have shown that it is of benefit in the treatment of rheumatoid arthritis (RA). " Recently Bax and Amos have stated that it is a safe drug for prolonged therapy. " This report describes two patients who were treated with sulphasalazine to control their active inflammatory arthritis and who developed severe neutropenia necessitating withdrawal of the drug. These two cases are compared with those of six others who developed transient leucopenia during treatment with SASP but who continued therapy under careful supervision. The eight patients reported are part of a study to evaluate the use of SASP in 180 patients with inflammatory forms of arthritis (150 with RA and 30 with seronegative inflammatory arthritides). Case reports PATIENT I A 43 year old man with a 19 year history of ankylosing spondylitis (with iritis and peripheral joint involvement) was treated with sulphasalazine to control his active joint disease. He had not previously received any second line agents. One month before receiving SASP he was started on 20 mg prednisone for iritis and was now on a decreasing Acccptcd for publicition 17 FcbruaryI 1986