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

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

Hello Dr.
Zeng, I am a patient with ankylosing spondylitis and have been experiencing symptoms for 2 years.
In the first year, I mainly 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 2 tablets of Celebrex and 1 tablet of Humira daily, and I have been on this regimen for a year now.
Two months after starting the Celebrex and Humira, I inexplicably developed new lower back pain (located at the same height as my navel), which has 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 new back pain, 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 symptoms are 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, should I stop the medication immediately to prevent any permanent damage to my body? Thank you, doctor.

Yang, 20~29 year old female. Ask Date: 2023/03/30

Dr. Zeng Guosen reply Internal Medicine

Is it true that the side effects of Seroquel need to be differentiated? If back pain is a side effect, it will not cause permanent harm to the body.
It is recommended to follow up with the attending physician for evaluation.

Reply Date: 2023/03/30

More Info

When considering the relationship between your new lower back pain and the medications you are taking, specifically Salazopyrin (sulfasalazine) and its potential side effects, it is important to approach this matter with a comprehensive understanding of both the medication and your underlying condition, ankylosing spondylitis (AS).

1. Understanding Salazopyrin and Its Side Effects: Salazopyrin is commonly used to treat inflammatory bowel disease and rheumatoid arthritis, and it can also be beneficial for ankylosing spondylitis. While it is generally well-tolerated, some patients report side effects, including gastrointestinal disturbances, headache, and, in some cases, musculoskeletal pain. The onset of your lower back pain two months after starting Salazopyrin raises a valid concern about whether this pain could be a side effect of the medication or a symptom of your underlying AS.

2. Differentiating Between Side Effects and AS Symptoms: The absence of systemic symptoms such as fever, rash, jaundice, diarrhea, or vomiting is reassuring and suggests that a severe adverse reaction to Salazopyrin is less likely. However, it is essential to recognize that AS itself can lead to new or worsening pain in the lower back, especially as the disease progresses. The inflammatory nature of AS can cause pain and stiffness in the spine and sacroiliac joints, which may be mistaken for medication side effects.

3. Assessment of Your Symptoms: Given that your lower back pain began after starting Salazopyrin, it is crucial to assess the characteristics of this pain. Is it constant or intermittent? Does it improve with rest or worsen with activity? These factors can help differentiate between medication-related pain and AS-related pain. Additionally, if you have a history of back pain that fluctuates with your AS activity, it may be more indicative of your condition rather than a side effect of the medication.

4. Consulting Your Healthcare Provider: It is vital to communicate your concerns with your healthcare provider. They can perform a thorough evaluation, including a physical examination and possibly imaging studies, to determine the cause of your new symptoms. If they suspect that Salazopyrin is contributing to your back pain, they may suggest adjusting your dosage or switching to an alternative medication.

5. Decision to Stop Medication: If your healthcare provider concludes that your lower back pain is indeed a side effect of Salazopyrin, they will guide you on the appropriate course of action. It is not advisable to stop any medication abruptly without consulting your doctor, as this could lead to a flare-up of your AS symptoms or other complications. Your doctor may recommend tapering the medication or switching to another treatment that may be more suitable for your condition.

In summary, while it is possible that your new lower back pain could be a side effect of Salazopyrin, it is equally plausible that it is related to the progression of your ankylosing spondylitis. A thorough discussion with your healthcare provider is essential to determine the best course of action, ensuring that both your AS and any potential medication side effects are effectively managed.

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

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