Can Increasing Salazopyrine Dosage Lower ESR in Ankylosing Spondylitis?

Q: Can Increasing Salazopyrine Dosage Lower ESR in Ankylosing Spondylitis?

Hello, thank you for your question. <br>Here are my responses：<br>1) I have been taking only 2 Salazopyrin daily, and my CRP has significantly decreased from around 0.7-0.9 (when I was only taking Celebrex or Voltaren) to now 0.2-0.4. <br>However, my ESR has shown almost no impro

Can increasing the dosage of Salazopyrin further reduce ESR?

Hello Doctor: I am 20 years old, and I 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 when I was only on 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 elevated (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 about 0.7-0.9 (when I was on Celebrex or Voltaren) to now 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 an improvement in my ESR? (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) Each time I have blood drawn, although my routine blood tests are normal, I have noticed that the parameters related to anemia are only at the lower limit of normal.
I would like to ask the doctor, do I have mild anemia? Could mild anemia be causing my ESR to be so high? Thank you, doctor.

Yong, 20~29 year old female. Ask Date: 2022/10/25

Dr. Gao Jiankai reply Internal Medicine

Hello, thank you for your question.
Here are my responses:
1) I have been taking only 2 Salazopyrin daily, and my CRP has significantly decreased from around 0.7-0.9 (when I was only taking Celebrex or Voltaren) to now 0.2-0.4.
However, my ESR has shown almost no improvement.
In this situation, if I increase the dosage of Salazopyrin to 3 or 4 pills a day, can I expect an improvement in my ESR? (Perhaps if my ESR improves, my pain might also further improve).
Note: I previously took 2 Salazopyrin and added 1 Voltaren daily, but after 3 months, my ESR still did not improve.
--> Taking 2 Salazopyrin daily might be a bit low, but any increase should be discussed with your attending physician.
I believe an increase is reasonable.
2) During each blood draw, although my routine blood tests are normal, I have noticed that the parameters 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 cause such a high ESR? --> Anemia can potentially elevate ESR levels, but if your hemoglobin is within the normal range, even at the lower limit, it should not be the cause of the elevated ESR.
The Allergy, Immunology, and Rheumatology Department of Changhua Hospital, Ministry of Health and Welfare, is concerned about you.

Reply Date: 2022/10/25

More Info

When it comes to managing Ankylosing Spondylitis (AS) with medications like Salazopyrine (Sulfasalazine), it is essential to understand how these medications work and their potential effects on inflammatory markers such as Erythrocyte Sedimentation Rate (ESR) and C-reactive protein (CRP).

Salazopyrine is an anti-inflammatory medication that is often used to treat inflammatory bowel disease and rheumatoid arthritis, and it has shown efficacy in treating AS. The mechanism of action involves the modulation of the immune response and reduction of inflammation. While you have observed a significant decrease in your hsCRP levels with the current dosage of Salazopyrine, the unchanged ESR levels can be perplexing.

To address your first question, increasing the dosage of Salazopyrine from two to three or four tablets per day may potentially lead to further improvements in your inflammatory markers, including ESR. However, the relationship between medication dosage and ESR is not always linear. ESR can be influenced by various factors, including the presence of other inflammatory conditions, individual variations in response to medication, and even the timing of the blood tests. Therefore, while increasing the dosage may help, it is not guaranteed that ESR will improve as expected. It is crucial to discuss any dosage adjustments with your healthcare provider, who can monitor your response and adjust the treatment plan accordingly.

Regarding your second question about anemia, it is important to note that mild anemia can indeed influence ESR levels. ESR is a nonspecific marker of inflammation, and it can be elevated in the presence of anemia. If your hemoglobin levels are at the lower end of the normal range, this could contribute to a higher ESR. Anemia can be caused by various factors, including chronic inflammation, nutritional deficiencies (such as iron, vitamin B12, or folate), or other underlying health conditions. If you suspect you have anemia, it would be wise to discuss this with your doctor, who may recommend further testing to determine the cause and appropriate treatment.

In summary, while increasing your Salazopyrine dosage may help improve your ESR and potentially alleviate pain, it is essential to approach this decision collaboratively with your healthcare provider. They can provide personalized advice based on your overall health status and treatment response. Additionally, addressing any underlying issues related to anemia may also be beneficial in managing your ESR levels and overall health. Regular monitoring and open communication with your healthcare team will be key to optimizing your treatment for Ankylosing Spondylitis.

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