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© 1989 British Society for Rheumatology

research-article

SULPHASALAZINE IN RHEUMATOID ARTHRITIS: HAEMATOLOGICAL PROBLEMS AND CHANGES IN HAEMATOLOGICAL INDICES ASSOCIATED WITH THERAPY

MARGARET FARR1, E. J. TUNN, DEBORAH P. M. SYMMONS, D. G. I. SCOTT and P. A. BACON

Department of Rheumatology, University of Birmingham, Medical School Birmingham B15 2TJ, UK

Correspondence to: 1Correspondence to Dr. Farr.

This prospective study documents the haematological responses in 300 rheumatoid patients (RA) treated with sulphasalazine (SASP) for between 1 and 9 years. It also examines the effect of SASP on the total white cell and platelet counts over 2 years in relation to disease activity in 80 RA patients.

Neutropenia occurred in six (2%) (three severe–neutrophil count >0.8xl09/l) after 3 and 12 weeks. The drug was withdrawn in six immediately and in one patient after 21 months when the neutrophil count fell to 0.7x 1099/1. An additional 11 (3.7%) developed mild or transient leucopenia between 2 weeks and 24 months, and eight continued therapy. Thrombocytopenia occurred in one patient at 18 weeks associated with other reactions. Four with Felty's syndrome developed a further fall in the total WBC associated with thrombocytopenia in two. A rise in mean cell volume was common (72%), and macrocytosis (MCV>98 fl) occurred in 27 (9%). Macrocytic anaemia was rare (>1%). All haematological problems were reversible.

In 80 patients treated with SASP for 2 years there was a significant fall in the median white cell and platelet counts at 3 months associated with improvement in disease activity.

KEY WORDS: Rheumatoid arthritis, Neutropenia, Leucopenia, Thrombocytopenia, Anaemia, Macrocytosis, Folic acid, Sulphazalazine, Monitoring


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