Can My Son Continue Taking Salazopyrin for Ankylosing Spondylitis?

Q: Can My Son Continue Taking Salazopyrin for Ankylosing Spondylitis?

Hello, thank you for your question. <br>Here is my response： <br>1) If my son experiences dizziness when getting up from a lying position due to mild anemia caused by the use of Salazopyrin, and no other causes for the dizziness can be identified, then we must weigh the two harms

Can I continue taking Salazopyrin?

Hello Doctor, my son is 20 years old and has been diagnosed with ankylosing spondylitis for 3 years.
For the past year and 4 months, he has been taking 2 tablets of Salazopyrin daily (without NSAIDs).
Previously, he was on NSAIDs (without Salazopyrin).
Before starting Salazopyrin, his lab results were as follows: Hb 13.5-14.5, RBC 5.0-5.4, PLT 260-310, and WBC 6.7-8.5.
After starting Salazopyrin, his results changed to: Hb 12.6-13.6, RBC 4.5-4.7, PLT 220-250, and WBC 6.0-8.0.

In the past six months, my son has reported that whenever he gets up from lying down, he feels slightly dizzy (not severe).
I have tried getting up from lying down myself and did not experience dizziness.
He has seen a family physician and an ENT specialist, but no cause for his anemia or any serious illness has been found.

I would like to ask the doctor:
1) If my son's dizziness upon standing up is a result of mild anemia caused by the slight suppression of hematopoiesis from Salazopyrin, and since no other causes for the dizziness have been identified, can we choose the lesser of two evils? (Salazopyrin is the only medication that effectively controls his condition; NSAIDs were not effective).
If stopping Salazopyrin would restore his hematopoietic function (as previously confirmed with Dr.
Gao), and the dizziness does not significantly impact his daily life, is it acceptable for him to continue taking Salazopyrin?
2) I would like to try giving my son some natural foods (not intentionally taking herbal supplements or medications) to improve his anemia symptoms.
Is this advisable? However, I am concerned that supplementing his blood might reduce the effectiveness of Salazopyrin.
Thank you, Doctor.

Zheng, 50~59 year old female. Ask Date: 2023/07/18

Dr. Gao Jiankai reply Internal Medicine

Hello, thank you for your question.
Here is my response:
1) If my son experiences dizziness when getting up from a lying position due to mild anemia caused by the use of Salazopyrin, and no other causes for the dizziness can be identified, then we must weigh the two harms and choose the lesser one (my son can only manage his condition with Salazopyrin, as previous NSAIDs were ineffective).
Additionally, after discontinuing Salazopyrin, my son's hematopoietic function will recover (I have previously confirmed this with Dr.
Gao).
Since the dizziness does not affect his daily life, is it acceptable for my son to continue taking Salazopyrin? --> Such hemoglobin levels rarely cause dizziness; it is more likely related to autonomic nervous system dysregulation.
I recommend encouraging the child to exercise more, as this can help soothe the autonomic nervous system and fulfill the basic requirement of regular exercise for ankylosing spondylitis, which may lead to improvement.
2) I would like to try giving my son some natural foods (not intentionally consuming traditional Chinese medicine or supplements) to improve his anemia symptoms.
Is this okay? However, I am concerned that supplementing his blood may reduce the effectiveness of Salazopyrin.
--> This can be attempted, and it will not affect the action of Salazopyrin.

Best regards from the Allergy, Immunology, and Rheumatology Department of Changhua Hospital, Ministry of Health and Welfare.

Reply Date: 2023/07/18

More Info

When considering the continuation of Salazopyrin (sulfasalazine) for your son, who has been diagnosed with ankylosing spondylitis (AS) for over three years, it is essential to weigh the benefits against the potential side effects. Salazopyrin is an anti-inflammatory medication that is commonly used to manage symptoms of AS, and it works by modulating the immune response and reducing inflammation.

1. Regarding the Dizziness: The dizziness your son experiences when rising from a lying position could indeed be related to the mild anemia that has developed since starting Salazopyrin. Anemia can lead to decreased oxygen delivery to the brain, especially when changing positions quickly, which may cause lightheadedness or dizziness. The blood tests you provided indicate a slight decrease in hemoglobin (Hb) and red blood cell count (RBC) since starting the medication, which could contribute to these symptoms. However, it is crucial to rule out other causes of dizziness, such as orthostatic hypotension, dehydration, or other underlying health issues. Since he has already consulted with a family physician and an ENT specialist without finding a significant cause, it may be reasonable to continue Salazopyrin while monitoring his symptoms closely. If the dizziness worsens or becomes more frequent, it would be prudent to revisit the healthcare provider for further evaluation.

2. Natural Remedies for Anemia: Introducing natural foods that are rich in iron, vitamin B12, and folate could help improve his anemia without significantly interfering with the efficacy of Salazopyrin. Foods such as leafy greens, beans, lentils, red meat, poultry, fish, nuts, and fortified cereals can be beneficial. Vitamin C-rich foods (like citrus fruits) can enhance iron absorption, especially from plant sources. However, it is essential to avoid excessive supplementation of iron or other vitamins without consulting a healthcare provider, as this could lead to imbalances or interactions with medications.

3. Monitoring and Communication with Healthcare Providers: It is crucial to maintain open communication with your son’s healthcare team. Regular monitoring of his blood counts is advisable to ensure that the anemia does not worsen. If you decide to continue Salazopyrin, it would be wise to schedule follow-up appointments to assess his response to the medication and any changes in his symptoms. If there are concerns about the anemia or if symptoms persist, the healthcare provider may consider adjusting the dosage or exploring alternative treatments.

4. Long-term Considerations: While Salazopyrin is effective for managing AS, long-term use can lead to side effects, including potential impacts on blood cell production. If your son’s symptoms of AS are well-controlled with Salazopyrin, it may be beneficial to continue the medication, but this should be done under the guidance of a healthcare professional. If you consider stopping the medication, it is essential to discuss this with his doctor, as they can provide a tailored approach based on his specific health needs.

In summary, it seems reasonable for your son to continue taking Salazopyrin while monitoring his symptoms and blood counts. Incorporating iron-rich foods may help with his anemia, but any changes to his medication regimen should be discussed with his healthcare provider to ensure his safety and the effectiveness of his treatment for ankylosing spondylitis.

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