British Journal of Rheumatology 1993;32313-318 RHEUMATOID ARTHRITIS: A RISK FACTOR FOR

The disease R A itself is assumed to be a risk factor for the occurrence of adverse drug reactions during sulphasalazine ther-apy. A meta-analysis comparing treatment termination because of toxicity among RA, inflammatory bowel disease and seronegative spondylarthropathy patients was conducted. It is shown that RA itself does not appear to predispose to treat-ment discontinuation because of adverse reactions. Differences found in the incidence of side effects among the various disease groups can probably be explained by patient selection, particularly with respect to age, proportion treated for the first time with sulphasalazine, and dosage used. The side effect profiles in the three groups studied are not different. How-ever, a trend towards greater haematological and hepatic toxicity in rheumatic patients is noticed. KEY WORDS: Sulphasalazine toxicity; Rheumatoid arthritis; Inflammatory bowel disease; Seronegative spondylarthro-pathy; Risk factor; Meta-analysis. DISEASE modifying anti-rheumatic drugs play a key part in the treatment of RA. An important restriction in prescribing DMARDs is that drug treatment must be abandoned in a high percentage of patients because of adverse drug reactions. It is proposed that RA itself appears to predispose to drug toxicity. RA patient