Exact mechanism is unknown, but there is evidence for antiinflammatory, immunomodulatory, antibacterial (in the colon), and folate metabolism actions. Selected Indications
RA, seronegative spondyloarthropathies. Metabolism
Sulfasalazine is partially absorbed (one-third) from the small intestines and extensively metabolized. It is split into 5-aminosalicylic acid and sulfapyridine; the latter is metabolized in the liver. The metabolic products are excreted in the urine.
The most common side effects, occurring in up to one-third of patients, include anorexia, headache, nausea, vomiting, gastric distress, and apparently reversible oligospermia. Rash, pruritus, urticaria, fever, and hemolytic anemia are less frequent. Rare reactions such as blood dyscrasia (especially leukopenia), hypersensitivity reaction, and central nervous system reaction have been reported.
Azulfidine is contraindicated in patients with porphyria and should be administered with caution in patients with hepatic or renal disease, blood dyscrasia, severe asthma, or allergies. Complete blood cell counts and liver function tests should be performed frequently. Urinalysis results should also be followed. Adequate fluid intake must be maintained to prevent crystalluria and renal stones. Patients with glucose-6-phosphate dehydrogenase deficiency should be followed closely for signs of hemolysis. Azulfidine should be avoided in patients with sulfa allergies and should not be given simultaneously with sulfa drugs.
Tablets, 500 mg.
The dosage is 2 to 3 g/d in divided doses with meals.
Although biologic agents may be broadly defined and will certainly be subject to redefinition as their use evolves, they generally describe specific antibodies or recombinant forms of natural inhibitors against modulatory molecules of immunity or inflammation. These agents have been most widely studied in the setting of RA, but they represent a new approach to the treatment of all systemic inflammatory rheumatic diseases. Only etanercept has been approved by the Food and Drug Administration thus far, but many more agents specific for various target molecules are in development.
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