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

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

Hello, thank you for your inquiry. <br>Here are my responses： <br>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 l

Why has the effect of Salbutamol diminished?

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, I was only taking Celebrex (without Salazopyrin).
I would like to focus on the period after March 2.
Since then, I have had five blood tests: March 2, 2022 (Hscrp 0.57, ESR 20), May 25, 2022 (Hscrp 0.20, ESR 39), September 19, 2022 (Hscrp 0.38, ESR 56), November 16, 2022 (Hscrp 0.91, ESR 22), and February 22, 2023 (Hscrp 1.05, ESR 32).
From March 2 to November 16, the Hscrp levels were well controlled, but after November 16, the Hscrp index rose to around 1 (and it has been around 1 for two consecutive tests).
I would like to ask the doctor: 1) For general ankylosing spondylitis patients, in the absence of special circumstances and with continuous use of Salazopyrin, is it possible for the medication to suddenly become ineffective? (The change seems quite significant from around 0.2 to 0.9 or 1.) 2) For the tests on November 16, 2022, and February 22, 2023, I forgot to take Salazopyrin for the two weeks prior due to other commitments.
Could this lapse in medication have caused the Hscrp index to rise to 1? 3) I was diagnosed with COVID-19 on October 10, 2022, which was considered a mild case, and I recovered in two weeks.
Could this diagnosis have contributed to the rise in Hscrp levels after November 16? 4) I have noticed that my buttock pain tends to occur more frequently during cold fronts.
Could the winter weather have caused the Hscrp index to rise to 1 after November 16? (However, it wasn't very cold before November 16.) I apologize for the numerous questions, and thank you, doctor.

Shao, 20~29 year old female. Ask Date: 2023/02/23

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.
However, is it possible for the effectiveness to suddenly diminish without explanation? (For instance, levels changing from around 0.2 or 0.4 to 0.9 or 1, which seems like a significant fluctuation.) --> HSCRP levels can fluctuate even with continuous use of Salazopyrin.
2) I forgot to take Salazopyrin for two weeks prior to my tests on November 16, 2022, and February 22, 2023.
Could this lapse in medication have caused my HSCRP levels to rise to 1? --> It is important not to stop Salazopyrin for extended periods, as this can affect the medication's efficacy and may lead to an increase in HSCRP levels.
3) I was diagnosed with COVID-19 on October 10, 2022, which was considered a mild case, and I recovered in two weeks.
Could this diagnosis have caused my HSCRP levels to rise to 1 after November 16? --> No, the time elapsed since the infection is significant, and it should not be related.
4) I have noticed that my buttock pain tends to worsen during cold weather.
Could this seasonal change have contributed to my HSCRP levels rising to 1 after November 16? (However, it wasn't very cold before November 16.) --> Weather changes can lead to joint pain, but they do not affect HSCRP levels.
Best regards from the Allergy, Immunology, and Rheumatology Department of Changhua Hospital, Ministry of Health and Welfare.

Reply Date: 2023/02/23

More Info

The effectiveness of Salazopyrine (Sulfasalazine) in managing Ankylosing Spondylitis (AS) can vary for several reasons, and it’s important to understand the underlying factors that may contribute to changes in its efficacy over time.
1. Variability in Disease Activity: Ankylosing Spondylitis is characterized by periods of flare-ups and remission. Even with consistent medication, the inflammatory nature of AS can lead to fluctuations in symptoms and laboratory markers such as High-Sensitivity C-Reactive Protein (HsCRP) and Erythrocyte Sedimentation Rate (ESR). It is not uncommon for patients to experience changes in disease activity that may not correlate directly with medication adherence. Factors such as stress, physical activity levels, and even seasonal changes can influence disease activity.

2. Medication Adherence: You mentioned that there were periods when you forgot to take Salazopyrine. Missing doses can lead to a resurgence of inflammation, as the medication needs to be taken consistently to maintain therapeutic levels in the body. The two-week gap in medication could indeed contribute to an increase in HsCRP levels, as the anti-inflammatory effects of the drug may diminish without regular intake.

3. Impact of COVID-19: Your history of COVID-19, even if mild, could have an impact on your immune system and inflammatory markers. Viral infections can trigger inflammatory responses, and it is possible that the immune response to the virus could have influenced your HsCRP levels post-infection.
4. Environmental Factors: You noted that your symptoms tend to worsen during colder weather. Environmental factors, including temperature and humidity, can affect joint pain and inflammation in AS patients. Cold weather can lead to increased muscle tension and discomfort, potentially exacerbating symptoms and influencing inflammatory markers.

5. Long-term Efficacy of Sulfasalazine: Over time, some patients may find that their response to Sulfasalazine diminishes. This could be due to the development of tolerance or changes in the disease itself. It is important to regularly evaluate the effectiveness of the treatment with your healthcare provider, as adjustments may be necessary based on your current symptoms and laboratory results.

In conclusion, the increase in HsCRP levels and the perceived decrease in the effectiveness of Salazopyrine could be attributed to a combination of factors, including medication adherence, disease activity fluctuations, the impact of recent infections, and environmental influences. It is crucial to maintain open communication with your healthcare provider about these changes. Discussing your observations, including the missed doses and any recent illnesses, will help your doctor tailor your treatment plan more effectively. They may consider adjusting your medication regimen, adding other therapies, or exploring additional diagnostic evaluations to ensure optimal management of your Ankylosing Spondylitis.

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