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sulfasalazine use
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sulfasalazine use
Does anyone here take sulphasalazine for flare ups? My doctor prescibes that along with lomotil for my flares. I have never taken Entecort but have taken prednisone for flare as well.
Hi Nancy,
Sulfasalazine is not very popular these days, because many people are sensitive to sulfa drugs, and because many people suffer adverse effects from one of the active moieties of sulfasalazine, (sulfapyradine), after the gut bacteria break down the drug, to activate it.
Sulfasalazine is a prodrug, that is to say, it does not become active in the digestive system until it is broken down by bacteria in the colon, into 5-aminosalicylic acid, (5-ASA), and sulfapyridine. While sulfapyradine has a therapeutic effect for rheumatoid arthritis, no beneficial effect from sulfapyradine has been observed for treating inflammatory bowel disease. Since many people tend to react adversely to sulfa drugs, sulfasalazine has mostly been replaced with mesalamine, (sometimes referred to as mesalazine, to further confuse the matter), in the treatment of IBDs.
Mesalamine contains the active moiety of sulfasalazine, known as 5-aminosalicyclic acid, while eliminating the sylfapyradine. Mesalamine is a derivative of salicylic acid, which means that it is related to NSAIDs. For many people who have an inflammatory bowel disease, NSAIDs have been shown to stimulate leukotriene production, which can cause inflammation and D. Therefore, virtually anyone subject to an IBD flare because of NSAIDs, will also react adversely to mesalamine and/or sulfasalazine.
Unless you have rheumatoid arthritis, mesalamine is a much safer drug to use, with regard to side effect risks, because many people with MC cannot tolerate sulfa drugs. However, sulfasalazine has been around for a long time, and is cheap to manufacture, so it's priced much lower than mesalamine.
IMO, (and this is strictly my unprofessional opinion), Entocort is far more effective, and generally safer, (especially after the dosage is tapered down to a low maintenance dose), than either sulfasalazine or mesalamine, (and it's certainly much, much safer to take than predisone). Mesalamine has been known to cause pancreatitis in a few cases, especially with long-term use, and the pancreas is not a good organ to inflame, because of it's vital digestive system functions.
Many GI docs are afraid of Entocort, because it is classed as a corticosteroid, but unlike the other corticosteroids, only up to 19% of the active ingredient, (budesonide), is ever absorbed into the bloodstream, so it is nowhere near as likely to cause the side effect risks of the other corticosteroids. Also, most GI docs are unaware of the risks of mesalamine causing pancreatitis, because that risk only becomes apparent if one does a lot of research on the internet, something that most GI docs seem loathe to do, for some unknown reason.
As far as price is concerned, though, sulfasalazine can't be beat. I hope this helps.
Tex
Sulfasalazine is not very popular these days, because many people are sensitive to sulfa drugs, and because many people suffer adverse effects from one of the active moieties of sulfasalazine, (sulfapyradine), after the gut bacteria break down the drug, to activate it.
Sulfasalazine is a prodrug, that is to say, it does not become active in the digestive system until it is broken down by bacteria in the colon, into 5-aminosalicylic acid, (5-ASA), and sulfapyridine. While sulfapyradine has a therapeutic effect for rheumatoid arthritis, no beneficial effect from sulfapyradine has been observed for treating inflammatory bowel disease. Since many people tend to react adversely to sulfa drugs, sulfasalazine has mostly been replaced with mesalamine, (sometimes referred to as mesalazine, to further confuse the matter), in the treatment of IBDs.
Mesalamine contains the active moiety of sulfasalazine, known as 5-aminosalicyclic acid, while eliminating the sylfapyradine. Mesalamine is a derivative of salicylic acid, which means that it is related to NSAIDs. For many people who have an inflammatory bowel disease, NSAIDs have been shown to stimulate leukotriene production, which can cause inflammation and D. Therefore, virtually anyone subject to an IBD flare because of NSAIDs, will also react adversely to mesalamine and/or sulfasalazine.
Unless you have rheumatoid arthritis, mesalamine is a much safer drug to use, with regard to side effect risks, because many people with MC cannot tolerate sulfa drugs. However, sulfasalazine has been around for a long time, and is cheap to manufacture, so it's priced much lower than mesalamine.
IMO, (and this is strictly my unprofessional opinion), Entocort is far more effective, and generally safer, (especially after the dosage is tapered down to a low maintenance dose), than either sulfasalazine or mesalamine, (and it's certainly much, much safer to take than predisone). Mesalamine has been known to cause pancreatitis in a few cases, especially with long-term use, and the pancreas is not a good organ to inflame, because of it's vital digestive system functions.
Many GI docs are afraid of Entocort, because it is classed as a corticosteroid, but unlike the other corticosteroids, only up to 19% of the active ingredient, (budesonide), is ever absorbed into the bloodstream, so it is nowhere near as likely to cause the side effect risks of the other corticosteroids. Also, most GI docs are unaware of the risks of mesalamine causing pancreatitis, because that risk only becomes apparent if one does a lot of research on the internet, something that most GI docs seem loathe to do, for some unknown reason.
As far as price is concerned, though, sulfasalazine can't be beat. I hope this helps.
Tex
It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.
I loathe sulfa. I cringe when I hear the name. For the three times I used it, I was sicker than a dog. When my dad got ill, they gave him a sulfa drug. He never had been given a sulfa drug before and was so allergic to it, it landed him in the hospital. Now I know where my sulfa reactions came from.
Mandy
Mandy
Nancy,
I haven't been at this as long as others but I have taken Prednisone, Sulfasalizine and Entocort.
Hands down, Entocort is the only med that is tolerable and effective. Prednisone is a stop gap and I was glad to have it because it got me back on my feet until I could get to the GI. My PCP also prescribed Sulfasalizine, saying it was the long term drug of choice. IMO that stuff is poison. With my LC I would be sick all morning. With Sulfasalizine I was sick 24/7. I took myself off it one week before my first appointment with my GI, after struggling with it for over 2 weeks.
When I asked the GI about Sulfasalizine she leaned forward, shook her head and said "we don't even use that stuff. There are much better meds that will help you". Which was good because there was no way I was going to take it again. IMO, it's nasty stuff . Entocort, and the advice of the members of this support group, have helped me make the gains I have.
Carol
I haven't been at this as long as others but I have taken Prednisone, Sulfasalizine and Entocort.
Hands down, Entocort is the only med that is tolerable and effective. Prednisone is a stop gap and I was glad to have it because it got me back on my feet until I could get to the GI. My PCP also prescribed Sulfasalizine, saying it was the long term drug of choice. IMO that stuff is poison. With my LC I would be sick all morning. With Sulfasalizine I was sick 24/7. I took myself off it one week before my first appointment with my GI, after struggling with it for over 2 weeks.
When I asked the GI about Sulfasalizine she leaned forward, shook her head and said "we don't even use that stuff. There are much better meds that will help you". Which was good because there was no way I was going to take it again. IMO, it's nasty stuff . Entocort, and the advice of the members of this support group, have helped me make the gains I have.
Carol
“.... people will forget what you said, people will forget what you did, but people will never forget how you made them feel.” Maya Angelou
Yes, azulfadine is sulfalsalazine. The proper way to eliminate the joint pain is to control the leaky gut syndrome. Azulfadine will make the leaky gut worse, if you are sensitive to NSAIDs, (because NSAIDs cause leaky gut, in the first place. That's how they trigger MC).
True, azulfadine may help with the joint pain, but taking it will probably guarantee that you will need to take it, (or something stronger), for the rest of your life, because it will perpetuate the leaky gut, which will perpetuate the joint pain.
Tex
True, azulfadine may help with the joint pain, but taking it will probably guarantee that you will need to take it, (or something stronger), for the rest of your life, because it will perpetuate the leaky gut, which will perpetuate the joint pain.
Tex
It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.
Belle,
The joint pain is caused by undigested peptides and antibodies leaking into your bloodstream, and being carried all over your body, and being deposited in your joints and organs. IOW, increased intestinal permeability is the problem, (leaky gut), and the pain can be eliminated, if the increased permeability can be reversed. The most common causes of leaky gut are alcohol, food-sensitivities, certain drugs, and candida overgrowth. For almost all of us, the primary cause of our leaky gut is food-sensitivities , and in most cases, gluten is the problem.
Pain-killers can cover the symptoms, but they won't eliminate the problem. The only way to do that is to make your diet squeaky clean. While it's possible for casein or soy to cause joint pain, the most common problem is always gluten, and it usually causes the worst joint pain. Acetaminophen, (Tylenol), can help, but other than narcotic-based painkillers, there aren't many safe options available for us.
I hear you, about how debilitating joint pain and stiffness can be. I recently had the same problem, caused by cross-contamination in my diet, by gluten. I was beginning to think that my pain and stiffness were simply due to old age, and there was nothing I could do about it, but after I made some changes, to avoid cross-contamination, my pain and stiffness slowly went away. Gluten is a very insidious enemy, and it will sneak into our diet at every opportunity, unless we do everything right, to keep it out of our food. Speaking from experience - if you have wheat flour in your kitchen, gluten is almost certainly in your food.
Tex
The joint pain is caused by undigested peptides and antibodies leaking into your bloodstream, and being carried all over your body, and being deposited in your joints and organs. IOW, increased intestinal permeability is the problem, (leaky gut), and the pain can be eliminated, if the increased permeability can be reversed. The most common causes of leaky gut are alcohol, food-sensitivities, certain drugs, and candida overgrowth. For almost all of us, the primary cause of our leaky gut is food-sensitivities , and in most cases, gluten is the problem.
Pain-killers can cover the symptoms, but they won't eliminate the problem. The only way to do that is to make your diet squeaky clean. While it's possible for casein or soy to cause joint pain, the most common problem is always gluten, and it usually causes the worst joint pain. Acetaminophen, (Tylenol), can help, but other than narcotic-based painkillers, there aren't many safe options available for us.
I hear you, about how debilitating joint pain and stiffness can be. I recently had the same problem, caused by cross-contamination in my diet, by gluten. I was beginning to think that my pain and stiffness were simply due to old age, and there was nothing I could do about it, but after I made some changes, to avoid cross-contamination, my pain and stiffness slowly went away. Gluten is a very insidious enemy, and it will sneak into our diet at every opportunity, unless we do everything right, to keep it out of our food. Speaking from experience - if you have wheat flour in your kitchen, gluten is almost certainly in your food.
Tex
It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.
Belle,
I can tell you that prior to my GI doc, and this site, suggesting that NSAIDS and gluten might be implicated in my LC, I would never have thought about stopping either. One year post-diagnosis, I have less joint pain after stopping dairy/gluten/NSAIDS(including Celebrex) than I did when I was taking/eating them. I have a good friend who has Rheumatoid Arthritis who has also stopped eating gluten, on her doc's recommendation, with significant relief to her joint pain. After finding this community and learning so much from the folks here, plus doing other reading, I cannot rationally discount the gluten/other food sensitivity connection, or the food sensitivity/inflammation connection.
After recent discussions with my PCP, their strategy from here on out with me is, Less is More. Their goal is to keep me off as many meds as possible, and to let me independently fuss with diet to the degree I feel I need to if it keeps me feeling good. I will never again look solely to medication as a remedy for what ails me.
Also, don't discount the benefits of exercise. I have significantly less joint pain when I keep active and moving. I walk, I do yoga, and I do a core-Pilates/strength-weights workout. I'm not clear on how old you may be, but I'm about to turn 60. Since quitting gluten (after a several month-long period of recovery) I have lost 10lbs. on the scale (which I attribute to losing bloat from reducing inflammation), gained lean muscle, and have more energy.
I can tell you that prior to my GI doc, and this site, suggesting that NSAIDS and gluten might be implicated in my LC, I would never have thought about stopping either. One year post-diagnosis, I have less joint pain after stopping dairy/gluten/NSAIDS(including Celebrex) than I did when I was taking/eating them. I have a good friend who has Rheumatoid Arthritis who has also stopped eating gluten, on her doc's recommendation, with significant relief to her joint pain. After finding this community and learning so much from the folks here, plus doing other reading, I cannot rationally discount the gluten/other food sensitivity connection, or the food sensitivity/inflammation connection.
After recent discussions with my PCP, their strategy from here on out with me is, Less is More. Their goal is to keep me off as many meds as possible, and to let me independently fuss with diet to the degree I feel I need to if it keeps me feeling good. I will never again look solely to medication as a remedy for what ails me.
Also, don't discount the benefits of exercise. I have significantly less joint pain when I keep active and moving. I walk, I do yoga, and I do a core-Pilates/strength-weights workout. I'm not clear on how old you may be, but I'm about to turn 60. Since quitting gluten (after a several month-long period of recovery) I have lost 10lbs. on the scale (which I attribute to losing bloat from reducing inflammation), gained lean muscle, and have more energy.
Suze
i'm still totally confused b/c as i've said, i've been off of gluten for three months and the joint pain started after i went off of it. Tex, there is no way i can ever elliminate gluten from my kitchen but i am really careful for myself. i have a large family and cannot get all of them to totally change their eating habits. i know so many celiacs who still cook with wheat for their family and they are fine and their blood tests are fine. How can that be? Soon is passover so I will really be cooking without any wheat in my kitchen. Do you think I will be able to see a difference in one week if elimination wheat and gluten grains totally will help?
Belle
I'm well aware of that, but everyone is different. Many of us are more sensitive to gluten than the average celiac. A lot of celiacs can tolerate food with over 200 ppm of gluten - some of us react at 10 ppm, (not all of us, of course). The celiac blood tests have such poor sensitivity that one can have celiac disease for years, before those tests will show a positive result, so all those people have to do is to reduce their gluten intake a bit, and their blood test results will be negative. The blood tests won't be positive unless most of the villi in the small intestine have been flattened. If only half of them are flattened, the blood tests will remain negative.Belle wrote:i know so many celiacs who still cook with wheat for their family and they are fine and their blood tests are fine. How can that be?
Another thing to consider is the fact that as a group, celiacs typically have very poor compliance to the GF diet. In one study, for example, of patients who complained that the diet didn't work for them, over half of them were found to still be ingesting gluten:
http://www.ncbi.nlm.nih.gov/pubmed/12190170Of the 49 patients with celiac disease, 25 were identified as having gluten contamination.
That's impossible to guess, but let's hope that might happen.Belle wrote:Do you think I will be able to see a difference in one week if elimination wheat and gluten grains totally will help?
It's a fact that virtually everyone in your situation desperately tries to find some reason why gluten is not their problem - that's the normal, default way of looking at it, and I can understand that, but what else can you blame it on? Something is causing your symptoms, and it's something in your diet. After everything gets sorted out, gluten almost always turns out to be the problem.
Also, please be aware that research shows that the magnitude of diagnostic markers for celiac disease, have absolutely nothing to do with the severity of symptoms.
http://www.dldjournalonline.com/article ... 1/abstract
Tex
It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.
It depends on your level of sensitivity, and how careful you are. You may need to take a med, to help out. There will probably be a "celiac pill" on the market in a couple of years, that might work in that type of situation.Tex
It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.