Kickas.org Forums Ankylosing Spondylitis General Discussion #1 AS Web Support Group Prednisone & Sulfasalazine

Hello to everyone!! I have not posted anything in quite a while as I try not to totally focus on my condition for the sake of mental clarity. I have however been forced to maintain a considerable level of focus on it because of the pain I've been in for the last couple of months. My primary pain is currently confined to my left heel (plantar fascitis(sp?)). I do have some other aches and pains in a variety of places, but the heel has become a real issue.
I was diagnosed about one year ago now and have only tried a couple of medications. The most recent, Mobic, was quite beneficial for a few months, but for the last month has been seemingly useless. I really dislike the idea of taking medicine for the rest of my life so when the Mobic stopped working I thought I may be able to tough it out through the pain but it has become obvious that that approach is'nt going to work. I finally spoke with my rheumy today, and she prescribed a 24 day cycle of prednisone beginning with 15mg per day and tapering down to 2.5mg per day for the last four days of the cycle. She also prescribed Sulfasalizine begining with 500mg per day for a few days and then working up to 2000mg per day over the next 15 days and maintaining that level for an indefinite period of time.
My question is this: I looked through all the pharmacy posts and found info on both of the medicines I am being prescribed, but has anyone used them together? Most of what I read about these two medicines was disconcerning (many side effects mentioned that I would prefer not to experience). Has anyone out there used these medications together? I was planning to start them tommorrow morning but now that I've looked in to them here I am pretty scared to start this tretment plan. Having to limp through large chunks of my day may not be as bad as experiencing the problems that it seems allot of people have with these drugs. Any information anyone could give me about the use of these drugs together would be helpful. My rheumy obviously feels that it is a good plan of action, but I would guess that she has never taken these two medicines.
I know this should probably be posted in the pharmacy section, but I wanted to get it to as many people as possible so that I can decide what I am going to do.

Chris,

Welcome to KickAS!

I'm a SpondyA, moving down the wrong direction, had it for many years. I've avoided nsaids for years as they make my overall condition worse, recently tried a couple of the COX-2 drugs Celebrex which is great and vioox may as well take smarties or M&M's but both irritate the gut and eyes.

I've been on oral preddy for 10 months and salazapyrine which is similar to Sulfasalazine (different brand) for 3 months.

I have Inflammatory Bowel Disease as well as the arthritis.

I started a similar preddy regime last Sept, it had good results but below a certain dose I have major issues again which do n't go away. I had a terrible flare after the new year when they dropped the steroid below my threshold. Normally restoring the preddy to 5mg fixes it but this time no.

Apart form some minor things like 15 mg of preddy making me feel a bit wired I've done very well on the steroid. But you need to stretch and do appropriate levels of exercise.

The salazapyrine gave me a little rash (the low intial- dose is to de sensitise you or check for reactions), when we stepped up to full dose I was very irritable which is now better and my gums were tingling and a bit sore.

However I'm slowly improving.

The Preddy is good it keeps my joints esp back, hips and neck loose, Range of motion and a lot of the inflammatory pain down and my gut is better.

I've noticed since being on the salazapyrine my arms and legs are better, including the wrists ankle and heels.

David

Thank you David...I appreciate your input. Most of what I've read about these medications has been pretty negative so it is comforting to hear a little positive info.

Thanks again!!

Hi Chris!

I've never been on both these meds at the same time, but I have been on Sulfasalazine for over a decade and have found it very helpful. In my humble little opinion your doc's choices make alot of sense. Sulfasalazine is known to be most beneficial for peripheral areas... like the heel pain that is causing you the most trouble. And if you tolerate prednisone well, this suggestion provides you a quick route towards knocking down the inflammation, and the short course will limit the negatives that can be associated with it.

I want to mention that sulfasalazine can take a full 3 - 6 months before starting to show benefit, so it is not something to take short term or use on & off. For me it has worked very very well, though of course some folks experience an allergic reaction. It is hard to know without trying a med for yourself, since everyone responds so differently. Anyways, I just wanted you to hear a positive story on Sulfasalazine; I've had no side effects or problems in all the years I've taken it. Unfortunately, prednisone is not a med I can take... my doc pulled me off it after only one day due to something that showed in bloodwork.

Good luck in your decision, and I do hope you'll find a combo that best suits your situation!

mig

Hi Chris,
Sorry to hear that the AS is getting more aggressive, but happy to hear that your doctor has a plan of action. It's sometimes worth it to at least give it a try and see what happens, especially if you're really uncomfortable.
I have been on the sulfa and pred at the same time and didn't experience any major side effects except that the sulfa did bother my stomach some so I was switched to a coated type that was much easier on my stomach. I don't remember the name, but if you do a search in the pharmacy section I am sure you'll find it.
I was on both drugs for a couple years then we finally realized that the sulfa wasn't doing much good so I was taken off from it, but I am still on the pred...been on it now for about 7 years. It is the only thing that seems to help and if I try to get below 20 mgs I go into a flare. It's not supposed to be used for long term, but the only major side effect I have had so far from it is the weight gain. I am hoping to go back on the cyclosporin soon and if it works well I can stop the pred before any of the major side effects occur.
So, that's my experience with the drugs.
Many people here have had good results with the sulfa. I did at first, but my body built up a tolerance to it as it does with most drugs. And the pred is good for short term to at least get the inflammation down. Lot's of people go on and off from it and some stay at a low dose for a good amount of time. Many are concerned at first about the side effects, but most drugs have them and it's always a "damned if we do, damned if we don't" situation that we just have to decide if it's worth it or not.
Hope you have good results if you decide to go ahead with the plan.
Hugs,
Lisa

Hi Chris,

I've been on Sulfasalazine + prednisolone once, and Sulfasalazine, prednisolone and MTX once. The first round of sulfa caused stomach problems, so we stopped it after a while. Two years later, we tried it again, but then I had a non-stop headache and threw in the towel after three months or so. Didn't note any benefits or other side effects, apart from really yellow pee. Sulfasalazine just isn't my drug.

Prednisolone didn't really cause any side effects the first year or so (I was on it 2,5 years straight, because my AS was very uncontrolled), but then I started getting pimples, gained weight in weird places and got increased hair growth. I look normal again, though. I've been on it for a few weeks since then and have had cortisone shots into inflamed joints, but I would never take cortisone long-term again

Nina

Been on the sulfasalazine almost a year. Helps with the stiffness, does nothing for pain.
Prednisone is great, felt like I could whip my weight in wildcats. Weight gain and irritability are a couple of the bad points. Apparently, males can't stay on it for long, or I would. Give it a try, a couple of good weeks are worth it.

Thanks to all of you who reponded to my post. You've reminded me of why this site is so valuable and important. The information you can obtain from people with actual experience (all of you) vs. the information from drs. is so much more useful.
Thanks again!!! :-)

Hi Neo,

Why cant males stay on pred for long ?

I am a male and have been on it for 10+ years

Adriaan

hello, I was on both also, in fact, I started sulfazalazine and at that time was still having bad flares at least once a month, so he put me on the rapid taper of pred. For some reason, which I can't remember now, I stopped taking the sulfz. and was off it for a mo or so. When I started taking it again, I was at the time on another taper of pred, and as it turns out, I was actually allergic to the sulfz. and if I had NOT been on the pred I would have had a much worse reaction. But you shouldn't worry too much about it. If you have a good pharmacist, you should be able to discuss this with them too. I am almost as close to my pharmacist as I am my rheumy. good luck,

Aimee