Can sulfasalazine therapy induce or exacerbate Wegener's granulomatosis?

Scand J Rheumatol. 2008 Jan-Feb;37(1):72-4. doi: 10.1080/03009740701607117.


Sulfasalazine (SSZ) can induce serological and clinical autoimmune reactions but the occurrence of SSZ-related Wegener's granulomatosis (WG) has not been reported before. We describe two patients with rheumatoid factor (RF)-positive rheumatoid arthritis (RA) who developed biopsy-proven WG with serious organ involvement during SSZ therapy. The pathogenetic mechanism that explains the relationship between SSZ and the occurrence of a de novo anti-neutrophil cytoplasmic antibody (ANCA)-related vasculitis or a flare is discussed. We propose that WG can be a rare complication of SSZ therapy and that this, like other autoimmune adverse events of this drug, is mediated by SSZ-induced apoptosis.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Aged
  • Antirheumatic Agents / adverse effects
  • Antirheumatic Agents / therapeutic use
  • C-Reactive Protein / metabolism
  • Cyclophosphamide / therapeutic use
  • Disease Progression*
  • Glucocorticoids / therapeutic use
  • Granulomatosis with Polyangiitis / drug therapy*
  • Granulomatosis with Polyangiitis / physiopathology*
  • Humans
  • Methylprednisolone / therapeutic use
  • Sulfasalazine / adverse effects*
  • Sulfasalazine / therapeutic use*


  • Antirheumatic Agents
  • Glucocorticoids
  • Sulfasalazine
  • Cyclophosphamide
  • C-Reactive Protein
  • Methylprednisolone