Is My New Lower Back Pain a Side Effect of Salazopyrin or AS Symptoms?

Q: Is My New Lower Back Pain a Side Effect of Salazopyrin or AS Symptoms?

Hello, thank you for your question. <br>Here is my response： <br>1) Starting from the second month after taking Salazopyrin, I developed new symptoms of back pain. <br>However, I have not experienced any rashes, fever, jaundice, pallor, diarrhea, headaches, vomiting, or any other

My new lower back pain symptoms could be indicative of ankylosing spondylitis, or they might be a side effect of taking Celebrex?

Hello, Doctor.
I am a patient with ankylosing spondylitis, and I have been experiencing symptoms for two years.
During the first year, I primarily took anti-inflammatory and pain relief medications, and my symptoms were limited to pain in the sacroiliac joint.
In the second year, I switched to taking two capsules of Celebrex and one capsule of Humira daily, and I have been on this regimen for a year now.

Two months after starting the Celebrex and Humira, I developed new symptoms of lower back pain (only lower back pain, at the level of my navel) that have persisted until now.
I have seen online that Celebrex can have side effects such as joint and muscle pain.
Therefore, I would like to ask the doctor:
1) Since the second month after starting Celebrex, although I have developed this new back pain symptom, I have not experienced any rashes, fever, jaundice, paleness, diarrhea, dizziness, vomiting, or any other physical discomfort.
Based on this rough description, can the doctor make a preliminary judgment on whether my new back pain symptom is more likely a side effect of Celebrex or a new symptom of my ankylosing spondylitis?
2) If the back pain is more likely a side effect of Celebrex, do I need to stop the medication immediately to prevent any permanent harm to my body? Thank you, Doctor.

Zhong, 20~29 year old female. Ask Date: 2023/03/29

Dr. Gao Jiankai reply Internal Medicine

Hello, thank you for your question.
Here is my response:
1) Starting from the second month after taking Salazopyrin, I developed new symptoms of back pain.
However, I have not experienced any rashes, fever, jaundice, pallor, diarrhea, headaches, vomiting, or any other physical discomfort.
Based on this rough description, can the doctor make a preliminary judgment on whether this new back pain is more likely a side effect of Salazopyrin or a new symptom of my ankylosing spondylitis? --> I believe it is more related to the symptoms of ankylosing spondylitis.
After all, in my clinical experience, the enteric-coated Salazopyrin and the pain relief capsules you are taking still have room for adjustment.
2) If the back pain is more likely a side effect of Salazopyrin, do I need to stop the medication immediately to prevent permanent harm to my body? --> I believe it is not necessary to stop the medication for the reasons mentioned above.
I recommend returning for a follow-up consultation with your prescribing physician.

Sincerely, the Allergy, Immunology, and Rheumatology Department of Changhua Hospital, Ministry of Health and Welfare.

Reply Date: 2023/03/29

More Info

When considering the potential side effects of Salazopyrin (sulfasalazine) in relation to your new lower back pain, it's essential to understand both the medication's profile and the underlying condition of ankylosing spondylitis (AS).
1. Understanding Salazopyrin and Its Side Effects: Salazopyrin is commonly used to treat inflammatory conditions, including rheumatoid arthritis and ankylosing spondylitis. While it is effective in managing inflammation, it can also have side effects. Some patients report musculoskeletal pain, which may include joint or muscle pain. However, this is not universally experienced and can vary from person to person. The absence of other systemic symptoms such as fever, rash, jaundice, diarrhea, or gastrointestinal distress is a positive sign, suggesting that a severe adverse reaction is less likely.
2. Differentiating Between Side Effects and AS Symptoms: The timing of your new lower back pain—occurring two months after starting Salazopyrin—raises the question of whether it is a side effect of the medication or a manifestation of your ankylosing spondylitis. AS is characterized by chronic inflammation of the spine and sacroiliac joints, which can lead to pain and stiffness. Given that you have a history of AS, it is plausible that the new back pain could be related to the progression of your condition rather than a direct side effect of Salazopyrin.
3. What to Do Next: If you suspect that the back pain is related to Salazopyrin, it is crucial to consult with your healthcare provider before making any changes to your medication regimen. They may recommend a thorough evaluation, which could include imaging studies or blood tests, to determine if the pain is due to AS progression or a side effect of the medication. If it is determined that the pain is indeed a side effect, your doctor may suggest alternative treatments or adjustments to your current regimen.

4. Immediate Action: It is not advisable to stop taking Salazopyrin abruptly without medical guidance, as this could lead to a flare-up of your underlying condition. Instead, discuss your symptoms with your doctor, who can provide tailored advice based on your specific situation. They may suggest a temporary reduction in dosage or switching to a different medication if necessary.

5. Monitoring Symptoms: Keep a detailed record of your symptoms, including the intensity and duration of your back pain, any other new symptoms, and how they correlate with your medication schedule. This information will be invaluable for your healthcare provider in making an informed decision about your treatment plan.

In conclusion, while it is possible that your new lower back pain could be a side effect of Salazopyrin, it is equally likely to be related to the natural course of ankylosing spondylitis. A thorough evaluation by your healthcare provider is essential to determine the cause and appropriate management of your symptoms. Always prioritize open communication with your healthcare team regarding any new or worsening symptoms while on medication.

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