Can Increasing Salazopyrin Dosage Improve ESR in Ankylosing Spondylitis?

Saleran significantly reduces CRP levels; can increasing the dosage also lead to a significant decrease in ESR?

Hello Doctor: I am 20 years old and have been diagnosed with ankylosing spondylitis for 3 years, with the diagnosis confirmed 1 year after the onset.
Initially, I was treated with either Celebrex or Voltaren, but for the past 7 months, I have been taking only 2 tablets of Salazopyrin daily.
During the year and a half of treatment with Celebrex or Voltaren, my CRP, ESR, and pain levels improved, but not to my satisfaction.
Since switching to only Salazopyrin, I have noticed that my hsCRP levels have dropped to between 0.2-0.4 mg/dL, and my pain has significantly improved (although it still persists, it is much better than when I was only on Celebrex or Voltaren).
However, my ESR remains unchanged and is still high (between 30-50).
I would like to ask the doctor:
1) With my current regimen of 2 tablets of Salazopyrin daily, my CRP has significantly decreased from around 0.7-0.9 to 0.2-0.4, but my ESR has shown almost no improvement.
In this situation, if I increase the dosage of Salazopyrin to 3 or 4 tablets daily, can I expect my ESR to improve? (Perhaps if my ESR improves, my pain could further decrease.) Note: I previously took 2 tablets of Salazopyrin along with 1 tablet of Voltaren daily, but after 3 months, my ESR still did not improve.
2) During each blood test, although my routine blood parameters are normal, I have observed that the values related to anemia are generally at the lower limit of normal.
I would like to ask the doctor, do I have mild anemia? Could mild anemia be contributing to my elevated ESR? Thank you, Doctor.

Ting, 20~29 year old female. Ask Date: 2022/10/17

Dr. Zeng Guosen reply Internal Medicine

1.
There are many bodily factors that can cause elevated ESR, and inflammation is just one of them.
Increasing the dosage of Salazopyrin to 3 or 4 tablets per day may be worth trying, but it may not necessarily be effective.
2.
Mild anemia is unlikely to cause such a high ESR.
Thank you for your question.

Reply Date: 2022/10/17

More Info

When it comes to managing Ankylosing Spondylitis (AS) with medications like Sulfasalazine (Salazopyrin), it’s essential to understand how dosage adjustments might impact inflammatory markers such as the Erythrocyte Sedimentation Rate (ESR) and C-reactive protein (CRP).
Firstly, it’s important to note that while Sulfasalazine is an effective disease-modifying antirheumatic drug (DMARD) used in the treatment of AS, its effects on ESR can be variable. ESR is a nonspecific marker of inflammation, meaning that while it can indicate the presence of inflammation in the body, it does not provide specific information about the underlying cause. In your case, you have observed a significant reduction in CRP levels with the current dosage of Sulfasalazine, which suggests that the medication is effectively managing some aspects of your inflammation. However, the fact that your ESR remains elevated indicates that there may be other factors at play.

1. Increasing Sulfasalazine Dosage: Increasing the dosage of Sulfasalazine from 2 to 3 or 4 tablets daily may potentially improve your ESR, but this is not guaranteed. The response to medication can vary significantly among individuals. Some patients may experience a decrease in ESR with higher doses, while others may not see any change. It’s also worth noting that the relationship between medication dosage and inflammatory markers is not always linear. Therefore, while it’s reasonable to discuss the possibility of increasing your dosage with your healthcare provider, it’s also important to set realistic expectations regarding the outcomes.

2. Impact of Anemia on ESR: Regarding your concern about anemia, it’s true that anemia can influence ESR levels. In general, anemia can lead to an increased ESR due to the reduced viscosity of the blood, which allows red blood cells to settle more quickly. If your hemoglobin levels are at the lower end of the normal range, it might contribute to the elevated ESR you are experiencing. However, it’s important to note that while anemia can affect ESR, it is not the sole factor. Other inflammatory processes related to AS can also keep ESR elevated.

In summary, while increasing your Sulfasalazine dosage might help improve your ESR, it’s crucial to have a comprehensive discussion with your healthcare provider about your treatment plan. They can assess your overall health, consider other potential factors contributing to your elevated ESR, and determine the best course of action. Additionally, if you suspect you have anemia, your doctor may recommend further testing to evaluate your blood counts and determine if any interventions are necessary.

In managing AS, it’s also beneficial to incorporate lifestyle modifications, such as regular exercise, physical therapy, and a balanced diet, which can complement your medication regimen and potentially improve your overall well-being. Always keep an open line of communication with your healthcare provider to ensure that your treatment plan is tailored to your specific needs and health status.

Similar Q&A

Why Did the Effectiveness of Salazopyrine Diminish for My Ankylosing Spondylitis?

Hello, Doctor Gao. I am a patient with ankylosing spondylitis, and my main symptom is pain in the buttocks. Since March 2 of last year, I have been taking two Salazopyrin daily and only taking Voltaren when I experience pain (the pain has improved significantly). Before March 2, ...

Dr. Gao Jiankai reply Internal Medicine
Hello, thank you for your inquiry. Here are my responses: 1) For patients with ankylosing spondylitis, in the absence of special circumstances and without interruption of medication, the use of Salazopyrin (sulfasalazine) generally maintains effective control over HSCRP levels....

Understanding High ESR Levels in Anemia and Ankylosing Spondylitis

Hello Doctor: I am a patient with ankylosing spondylitis, 20 years old, and I have been diagnosed for over 2 years. Recently, for the past 7 months, I have been taking Salazopyrin, and during my last two follow-up visits, my hsCRP levels were 0.2 and 0.4, with very mild symptoms ...

Dr. Zeng Guosen reply Internal Medicine
1. Hemoglobin (Hb) levels of 13.5 to 14.5 are not the cause of abnormal erythrocyte sedimentation rate (ESR), as ESR can be influenced by many factors in the body. 2. C-reactive protein (CRP) is more important than ESR for monitoring ankylosing spondylitis; symptoms and X-rays a...

Can Immune Modulators Like Salazopyrin Reduce Severe COVID-19 Risk?

Hello Doctor, I have ankylosing spondylitis and I am currently 20 years old. I am taking two Salazopyrin (500 mg each) and one Methotrexate daily as part of my stable treatment. Recently, I have seen news reports mentioning that immunomodulators are used to treat moderate to seve...

Dr. Gao Jiankai reply Internal Medicine
Hello, thank you for your inquiry. Here are my responses: 1) From a theoretical standpoint, could it be that because I am taking Salazopyrin, I am less likely to develop moderate to severe symptoms after contracting COVID-19 compared to others of the same age and condition who ...

How Long Does It Take for Medications to Relieve Ankylosing Spondylitis Pain?

Hello Doctor: 1) For patients with ankylosing spondylitis experiencing sacroiliac joint pain, if they find relief with Celebrex (celecoxib), how long should they take it to achieve complete pain relief? Similarly, if they find relief with Salazopyrin (sulfasalazine), how long s...

Dr. Gao Jiankai reply Internal Medicine
Hello, thank you for your question. Here are my responses: 1) For patients with ankylosing spondylitis experiencing sacroiliac joint pain, if they find relief with Celebrex (celecoxib), it typically takes a few days (usually less than a week) to notice an effect. We usually mon...